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Öğe Alkolik Olmayan Yağlı Karaciğer Hastalığı Rekürren Akut Pankreatit için Bir Risk Faktörü müdür?(2020) Kutlu, Orkide; Bilgiç, Yılmaz; Bahri, Evren; Çağın, Yasir Furkan; Atayan, YahyaAmaç: Akut pankreatit (AP), pankreasın oto-digestif, inflamatuar bir hastalığı olup, hastaların dörtte bir kadarında rekürren akut pankreatit (RAP)ataklarıyla karşılaşılabilmektedir. Çalışmamızın amacı, RAP’li hastalarda alkolik olmayan yağlı karaciğer hastalığı (NAYKH) birlikteliğinin AP’lihastalardan farklı olup olmadığını incelemektir.Gereç ve Yöntem: 2014-2017’de AP öntanısıyla gastroenteroloji kliniğine yatırılmış hastalar retrospektif olarak tarandı. Atlanta kriterlerine göre APtanısı konulan ve AP etiyolojisi alkol olmayan toplam 428 hasta çalışmaya dâhil edildi. Birden fazla atak geçiren 40 hasta RAP olarak tanımlandı.Hasta grupları yaş, hemoglobin, platelet, AST, ALT, ALP, GGT, total bilirübin, direkt bilirübin, kalsiyum, TG ölçümleri; kese operasyonu, ERCPişlem sayısı, karaciğer USG ve pankreas USG raporlarına göre istatistiksel olarak karşılaştırıldı.Bulgular: AP’li hastalarda grade I, II ve III yağlanma oranları sırasıyla %8, %10.8 ve %14.6 olup %66.6 hastada steatoz saptanmadı. RAP’li hastalarda grade I, II ve III yağlanma oranları ise sırasıyla %5, %12.5 ve %10 saptandı, %72.5 hastada steatoz saptanmadı. AP ile RAP grupları karşılaştırıldığında hepatobilier USG’de karaciğer yağlanması açısından istatistiksel açıdan anlamlı fark saptanmadı (p =0.761). Hastalarımızda RAP oranı%9.34 olarak bulundu. Her iki hasta grubu arasında değerlendirilen biyokimyasal parametreler içinde sadece TG değerleri RAP grubunda anlamlıyüksekti (p =0,002). Ayrıca RAP grubunda ERCP yapılan hastalar, anlamlı oranda yüksek saptandı (p =0,003).Sonuç: RAP’li hastalarda NAYKH sıklığı AP’li hastalar ile benzer saptandı. AP rekürrensleri etiyolojisinde NAYKH rolünü netleştirmek için bualanda yapılacak yeni çalışmalara ihtiyaç olacaktır.Öğe Amenore ile seyreden De Morsier Sendromu: Olgu sunumu(2015) Kutlu, Orkide; Şahin, İbrahim; Sakin, Abdullah; Evren, BahriÖz: Septa Optik Displazi, De Morsier Sendromu olarak da bilinen nadir bir konjenital durumdur. Sendromun klasik triadındaki bulgular; beyin orta hat yapılarında anomaliler, optik sinir hipoplazisi ve hipofiz hormon disfonksiyonlarıdır. Triaddaki bulguların en az ikisinin bulunması ile tanı konulur. Burada primer amenore ile gelen ve de Morsier sendromu tanısı konulan bir olguyu sunduk. Optik sinir hipoplazisi, hipofizer yetmezlik veya beyin orta hat yapılarda anomali saptanması durumunda triada ait diğer bulguları araştırmalıdır ve gereğinde hormon replasman tedavileri başlanmalıdır.Öğe Can mean platelet volume (MPV) and platelet/lymphocyte ratio(2020) Gokden, Yasemin; Kutlu, OrkideAim: Investigating serum mean platelet volume (MPV) and platelet/lymphocyte ratio (PLR) levels in acute pancreatitis (AP) patients, and evaluating whether MPV and PLR estimate AP disease severity efficiently at early phase.Material and Methods: One hundred and forty patients diagnosed with AP and 49 healthy controls (HC) have been included in the study. Ranson criteria, revised Atlanta criteria and Balthazar scores of AP patients have been found from hospital registration systems, and mild-severe AP patients have been separated. MPV and PLR levels at admission were checked for the patients.Results: While no difference was determined between AP group and HC group with regard to MPV levels (p:0.998), PLR levels was determined to be higher in AP group than HC group (p0.001). No difference was determined between mild-severe AP patients with regard to MPV according to Ranson criteria, revised Atlanta criteria and Balthazar scoring (p:0.355; p:0.276; p:0.634, respectively). PLR was determined to be higher in severe AP group according to revised Atlanta criteria (p:0.023). However, no relation was determined between PLR and Ranson and Balthazar scoring (p:0.311, p:0.415, respectively). Upon grouping AP patients as biliary and non-biliary according to their etiology, MPV was determined to be lower in non-biliary AP patients (p:0.034). There was no difference between groups with regard to PLR (p:0.0772).Conclusion: MPV is not suitable for differentiating mild-severe AP patients at early period. PLR may be used as a supporting test in estimating severe AP patients at admission.Öğe Comparison of patients with fulminant versus near-miss fulminant drug-induced hepatitis(Allied Acad, 2017) Bilgic, Yilmaz; Akbulut, Sami; Kutlu, Orkide; Yilmaz, Cengiz; Colak, Cemil; Deviren, Mehmet Veysi; Cagin, Yasir FurkanThis study aimed to investigate and compare clinical and laboratory properties of patients with fulminant versus near-miss fulminant drug-induced hepatitis and the effect of these properties on mortality. Drug-induced hepatitis is the most common cause of acute liver failure in western countries. In severe drug-induced hepatitis, once encephalopathy develops, prognosis is poor without liver transplantation. Therefore, it is important to predict prognosis and know the clinical differences between patients developing encephalopathy and patients without encephalopathy. Patients with severe drug-induced hepatitis were researched retrospectively. The identified patients were divided into two groups: with encephalopathy (fulminant hepatitis; 25 patients) and without encephalopathy (near-miss fulminant hepatitis; 48 patients). The clinical properties and biochemical results of the two groups were compared, and parameters that could have an effect on mortality were evaluated. Hemoglobin, platelet count, albumin, and fibrinogen levels were found to be decreased, whereas, International Normalized Ratio (INR), total bilirubin, AST, LDH, lactate, and ammonia levels were found to be increased significantly in the fulminant hepatitis group. Creatinine, Model for End-Stage Liver Disease (MELD) score, and platelet count were found to be independent risk factors on mortality. The development of hepatic encephalopathy negatively impacts patient survival. Therefore, the prediction of a progression to fulminant hepatitis before hepatic encephalopathy develops and the clinical follow-up of patients accordingly are important issues. This study can provide significant insight into patients with severe drug-induced hepatitis.Öğe Could platelet indices be prognostic biomarkers for mild or severe acute pancreatitis?(E-Century Publishing Corp, 2016) Bilgic, Yilmaz; Akbulut, Sami; Kutlu, Orkide; Colak, Cemil; Yilmaz, Cengiz; Seckin, Yuksel; Cagin, Yasir FurkanThe aim of this study was to show the relation of platelet indices with the severity of acute pancreatitis (AP) and if they have any correlation with the severity of AP. Forty-seven patients with AP hospitalized in Department of Gastroenterology, Inonu University Faculty of Medicine were divided into two groups, namely, the severe AP group (n=15) and the mild AP group (n=32). The scores of these patients at days 0, 3 and at the beginning of remission according to the prognostic scoring systems (Ranson, APACHE II, and BISAP criteria), CRP, sedimentation and platelet indices (platelet count, MPV, PDW and PCT) were noted. Mann-Whitney U test was used to compare the groups. Spearman's Rho test was used to evaluate the correlations between the platelet indices and other prognostic factors. Significant differences were found between the groups as regards platelets (P<0.02), PDW (P<0.001), AST (P<0.001), ALT (P<0.001), Total bilirubin (P<0.007), LDH (P<0.001), CRP (P<0.001), sedimentation (P<0.001), APACHE-II (P<0.001), Ranson (P<0.002) parameters. When considered for the correlation between the platelet indices and other prognostic factors, it was seen that all the platelet indices showed strong positive or negative correlation in mild AP with other prognostic scoring systems, CRP and sedimentation. In contrast, it was seen that platelet indices in severe AP cases did not show strong correlation with other prognostic scoring systems, CRP and sedimentation. We showed that platelet derivatives can be used as a good prognostic biomarker for the course of mild AP. In severe AP cases, however, usability of platelet indices must be supported with further studies.Öğe Evaluation of antibiotic resistance patterns of Klebsiella isolates: Five-year observation(2019) Arabaci, Cigdem; Kutlu, OrkideAim: Klebsiella spp. is a gram-negative rod, having many virulence factors such as capsule polysaccharides, adhesins, and determinants for iron acquisition. In this study, we aimed to determine the sub-species of Klebsiella spp. and their antibiotic resistance profiles isolated from a tertiary hospital in a five-year period.Material and Methods: The antibiotic resistance profiles of Klebsiella spp. isolated from various clinical specimens of patients between January 2014 and December 2018 were retrospectively reviewed.Results: In a total of 4506 isolates were investigated. Among those isolates, 2,254 were obtained from females and 2.252 were obtained from males. The mean age of the patients was 47.71±29.56 while the median age was 56 years. On the other hand, 2.150 (47.7%) of the isolates were obtained from hospitalized patients, while 2356 (52.3%) were obtained from outpatients. Among those isolates, 1.859 (41.3%) were ESBL positive and along with ESBL positive isolates, 802 were obtained from females and 1,057 were obtained from males and ESBL positivity was significantly more common in males (p:0.001). Moreover, ESBL positivity was significantly more common in patients older than 18 years of age compared with the patients younger than 18 years of age. Ciprofloxacin resistance was reaching 67.4% and Ertapenem resistance was as high as 39.1% in ESBL positive Klebsiella spp. Conclusion: In conclusion, ESBL positive and carbapenem resistant Klebsiella spp. strains are increasing. Multidrug resistant Klebsiella spp. strains may cause severe infections increasing mortality. In that aspect, the antibiotic resistance profile should be identified clearly and further studies regarding the preventive measures should be planned.Öğe Gastric Hepatoid Adenocarcinoma: A Case Report and Literature Update(2015) Ecirli, Şamil; Akgül, Yavuz Sultan Selim; Kutlu, Orkide; Güngör, Gökhan; Sakin, AbdullahAbstract:Hepatoid adenokarsinomalar (HAC) çok nadir rastlanan ve oldukça kötü prognozlu ekstrahepatik tümörlerdir. Bu tümörlerin büyük çoğunluğu serumda AFP yüksekliği ile tanınmaktadır. İnsidansı en sık görüldüğü Uzakdoğu için gastrik tümörlerin %1,3-15 olarak bildirilmiş, diğer bölgelerden vakalar şeklinde bildirim mevcuttur. İyi differansiye papiller/tubuler ve poligonal hücrelerden oluşan medüller tip olmak üzere iki tipi tanımlanmıştır. AFP, CEA, CK7 ve CK20 nin survi üzerine etkisi gösterilmiştir. HAC lar da klasik mide adenokarsinomaları gibi tedavi edilmeye çalışılır. Adjuvan kemo-radyoterapi verilebilir. Midenin hepatoid adenokanseri kötü prognozludur. Genellikle tanı konduğunda metastatik olup, ortalama yaşam beklentisi 4,7 aydır. Burada kliniğimizde hepatoid adenokarsinoma tanısı koyduğumuz ve kemoterapiye dirençli hastamızı nadir rastlanması sebebi ile sunduk.Öğe Gastric Hepatoid Adenocarcinoma: A Case Report and Literature Update(2015) Ecirli, Şamil; Akgül, Yavuz Sultan Selim; Kutlu, Orkide; Güngör, Gökhan; Sakin, AbdullahAbstract:Hepatoid adenokarsinomalar (HAC) çok nadir rastlanan ve oldukça kötü prognozlu ekstrahepatik tümörlerdir. Bu tümörlerin büyük çoğunluğu serumda AFP yüksekliği ile tanınmaktadır. İnsidansı en sık görüldüğü Uzakdoğu için gastrik tümörlerin %1,3-15 olarak bildirilmiş, diğer bölgelerden vakalar şeklinde bildirim mevcuttur. İyi differansiye papiller/tubuler ve poligonal hücrelerden oluşan medüller tip olmak üzere iki tipi tanımlanmıştır. AFP, CEA, CK7 ve CK20 nin survi üzerine etkisi gösterilmiştir. HAC lar da klasik mide adenokarsinomaları gibi tedavi edilmeye çalışılır. Adjuvan kemo-radyoterapi verilebilir. Midenin hepatoid adenokanseri kötü prognozludur. Genellikle tanı konduğunda metastatik olup, ortalama yaşam beklentisi 4,7 aydır. Burada kliniğimizde hepatoid adenokarsinoma tanısı koyduğumuz ve kemoterapiye dirençli hastamızı nadir rastlanması sebebi ile sunduk.Öğe Gastrik hepatoid adenokarsinoma: olgu sunumu ve literatür güncellemesi(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2015) Ecirli, Şamil; Akgül, Yavuz Sultan Selim; Kutlu, Orkide; Güngör, Gökhan; Sakin, AbdullahHepatoid adenokarsinomalar (HAC) çok nadir rastlanan ve oldukça kötü prognozlu ekstrahepatik tümörlerdir. Bu tümörlerin büyük çoğunluğu serumda AFP yüksekliği ile tanınmaktadır. İnsidansı en sık görüldüğü Uzakdoğu için gastrik tümörlerin %1,3–15 olarak bildirilmiş, diğer bölgelerden vakalar şeklinde bildirim mevcuttur. İyi differansiye papiller/tubuler ve poligonal hücrelerden oluşan medüller tip olmak üzere iki tipi tanımlanmıştır. AFP, CEA, CK7 ve CK20 nin survi üzerine etkisi gösterilmiştir. HAC lar da klasik mide adenokarsinomaları gibi tedavi edilmeye çalışılır. Adjuvan kemo-radyoterapi verilebilir. Midenin hepatoid adenokanseri kötü prognozludur. Genellikle tanı konduğunda metastatik olup, ortalama yaşam beklentisi 4,7 aydır. Burada kliniğimizde hepatoid adenokarsinoma tanısı koyduğumuz ve kemoterapiye dirençli hastamızı nadir rastlanması sebebi ile sunduk.Öğe Predictive value of red cell distrubition width and C reactive protein/albumin ratio in determining severe acute pancreatitis(2020) Gokden, Yasemin; Kutlu, OrkideAim: To determine the relationship of red cell distribution width (RDW) and C-reactive protein (CRP)/albumin ratio with Ranson criteria, 2012 revised Atlanta Scoring and Balthazar Scoring in patients with acute pancreatitis (AP), which are used in daily practice to estimate the AP severity.Material and Methods: RDW was documented from the complete blood count at the time of patient admission to the hospital. On the second day of hospitalization, the CRP/albumin ratio was calculated as the ratio of absolute CRP to albumin. The relationship between the patients’ RDW levels and CRP/albumin ratio, with the length of hospital stay, and Ranson, Revised Atlanta criteria and Balthazar scores were investigated.Results: In a total of 152 patients with a mean age of 51.58 ± 15.58 years (range: 19-76) were included in the study. Among participants 82 (53.9%) were female and 70 (46.1%) were male. Among study participants, according to Ranson criteria, 117 were having mild and 35 were having severe AP; regarding Atlanta classification, 116 were having mild and 36 were having severe AP and according to the Baltahazar classification 122 were having mild-moderate and 30 were having severe AP. The mean hospitalization period was 7.14 ±4.17 days (range: 2-27 days). RDW and CRP/albumin ratio are compared between mild-moderate and severe AP groups defined with Ranson, Atlanta and Baltahazar classifications. There was not any significant difference between groups regarding RDW values; however, CRP/albumin ratio was significantly different between groups defined with all three classifications (p: 0.001). There was not any correlation between RDW and any of the scores or hospitalization period; however, CRP/albumin ratio showed significant moderate correlation with all of the scores and hospitalization period.Conclusion: We suggest that, CRP/albumin ratio is a good prognostic marker in predicting severe AP; however RDW values did not have any predictive value regarding the severity of AP.Öğe SEVERE HYPERBILIRUBINEMIA DURING FAMILYAL MEDITERRANEAN FEVER ATTACK IN PATIENTS WITH GILBERT'S SYNDROME(Istanbul Univ, Faculty Medicine, Publishing Office, 2016) Kutlu, Orkide; Keskin, Muharrem; Basturk, Abdulkadir; Ecirli, Samil; Bilgic, Yilmaz; Fisekci Oktar, SevilFamilial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by fever and accompanying attacks of serositis. Cytokines such as IL-6, TNF-alpha, IL-1 beta are known to play an active role in FMF pathogenesis. Gilbert's syndrome, is a clinical condition that results indirect hyperbilirubinemia during febrile illness, surgery, vomiting and prolonged fasting period because of inhibition of UDP-glucuronide transferase activity. Increased bilirubin levels during FMF attack is caused suppression of UDP-glucuronide transferase activity by cytokines involved in the pathogenesis of FMF. Here, we report a patient who had serious indirect bilirubin elevation during an attack of FMF.
