Muammer Bilici

Assessment of the correlation between serum prolidase and alpha-fetoprotein levels in patients with hepatocellular carcinoma

AIM To determine the predictive value of increased prolidase activity that reflects increased collagen turnover in patients with hepatocellular carcinoma (HCC). METHODS Sixty-eight patients with HCC (mean age of 69.1 ± 10.1), 31 cirrhosis patients (mean age of 59.3 ± 6.3) and 33 healthy volunteers (mean age of 51.4 ± 12.6) were enrolled in this study. Univariate and multivariate analysis were used to evaluate the association of serum α-fetoprotein (AFP) values with HCC clinicopathological features, such as tumor size, number and presence of vascular and macrovascular invasion. The patients with HCC were divided into groups according to tumor size, number and presence of vascular invasion (diameters; ≤ 3 cm, 3-5 cm and ≥ 5 cm, number; 1, 2 and ≥ 3, macrovascular invasion; yes/no). Barcelona-clinic liver cancer (BCLC) criteria were used to stage HCC patients. Serum samples for measurement of prolidase and alpha-fetoprotein levels were kept at -80 °C until use. Prolidase levels were measured spectrophotometrically and AFP concentrations were determined by a chemiluminescence immunometric commercial diagnostic assay. RESULTS In patients with HCC, prolidase and AFP values were evaluated according to tumor size, number, presence of macrovascular invasion and BCLC staging classification. Prolidase values were significantly higher in patients with HCC compared with controls (P < 0.001). Prolidase levels were significantly associated with tumor size and number (P < 0.001, P = 0.002, respectively). Prolidase levels also differed in patients in terms of BCLC staging classification (P < 0.001). Furthermore the prolidase levels in HCC patients showed a significant difference compared with patients with cirrhosis (P < 0.001). In HCC patients grouped according to tumor size, number and BCLC staging classification, AFP values differed separately (P = 0.032, P = 0.038, P = 0.015, respectively). In patients with HCC, there was a significant correlation (r = 0.616; P < 0.001) between prolidase and AFP values in terms of tumor size, number and BCLC staging classification, whereas the presence of macrovascular invasion did not show a positive association with serum prolidase and AFP levels. CONCLUSION Considering the levels of both serum prolidase and AFP could contribute to the early diagnosing of hepatocellular carcinoma.

Is Mean Platelet Volume a Reliable Marker to Predict Ischemic Stroke in the Follow-Up of Patients with Carotid Stenosis?

BACKGROUND The objective of the study is to evaluate the reliability of mean platelet volume (MPV) for predicting ischemic stroke (cerebrovascular event [CVE]) among patients with different degrees of carotid stenosis. METHODS Fifty-two patients with CVEs, 136 patients with carotid artery disease (CAD), and 40 healthy volunteers were enrolled in this study. All participants were divided into the following groups according to CAD: absence of stenosis, less than 50% stenosis, 50%-69% stenosis, and 70% or more to total occlusion of the internal carotid artery. For each participant, the parameters of CAD were assessed using ultrasonography. To obtain the values of CRP and MPV and the leukocyte and platelet counts, all samples were processed within 30 minutes after blood collection. Univariate and multivariate analyses were used to evaluate the association between the values of serum C-reactive protein (CRP) and MPV and carotid stenosis. RESULTS In terms of age and gender, there was no statistically significant difference between the groups (P = .094 and P = .428, respectively). However, CRP values in patients with CAD and CVEs were significantly higher than those in the controls (P < .001). There was no statistically significant difference between the CRP values in patients with CAD and CVEs (P = .249). Moreover, the MPV values did not show any significant difference between the groups (P = .053) and among the patients with CAD (P = .64). There was no positive correlation between serum CRP and MPV values in patients with CAD regarding the degree of carotid stenosis (r = .061, P = .477). CONCLUSION The findings of this study claim that MPV has no predictive value during follow-up of the patients with CAD for CVEs.

Disseminated tuberculosis in a non immun compromised patient with a complicated diagnosis

Tuberculosis (TB) has become a global emergency worldwide. The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis. Herein, we report a case of 64-year-old female patient suffering from dyspepsia, anorexia, weight loss and abdominal pain for the last 8 months. Physical examination, ascites fluid evaluation, chest radiography, ultrasonographic and tomographic scans, histopathological analysis of the lymphadenopathy (LAP) and endometrial tissue revealed TB. A fourfold antituberculous treatment with isoniazid, pyrazinamide, rifampicin and ethambutol was prescribed for two months and for four months maintenance therapy with isoniazid and rifampicin was given. On the fourth month of the medical treatment the patient clinically recovered. Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis.

The value of blood cell markers in patients with thyroid nodules including atypia of undetermined significance/follicular lesion of undetermined significance cytology -

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous that cannot be definitively diagnosed as benign, malignancy-suspect, or malignant. This study was conducted to evaluate the ability of mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) to predict the malignant potential of nodules diagnosed as AUS/FLUS. We retrospectively analyzed 101 patients for whom thyroid fine needle aspiration biopsy (FNAB) analysis indicated AUS/FLUS and who underwent surgery between 2011 and 2015. Demographic, laboratory, and histopathological data were obtained from a database. The patients were categorized into two groups: malignant or benign and comparisons between groups were performed. Of the 101 patients, 26 (25.7%) had solitary nodules and 75 (74.3%) had multinodulary goiter. The malignancy rate was 33.7%, and there were no differences between the two groups in terms of age, gender and thyroid function tests. Median preoperative red cell distribution width (RDW) level was 13.4 in the benign group, while it was 14.4 in patients with malignancy, demonstrating a significant correlation. Both MPV and NLR were elevated in malignant nodules. The malignancy risk of AUS/FLUS evident upon thyroid FNAB was higher than anticipated by the Bethesda system (BS). MPV, NLR and RDW are useful for estimating the malignancy risks of these diseases.

Commonness of Factor V Leiden, Prothrombin G20210A and Methylenetetrahydrofolate Reductase C677T Mutations among Patients with Thromboembolism in the Western Black Sea (Zonguldak) Region of Turkey

Introduction: Venous thromboembolism (VTE) remains a life-threatening disease. Screening for inherited risk factors in selected patients may have an impact on treatment approaches to VTE. In this study, we aimed to assess the frequency of factor V Leiden (FVL), prothrombin G20210A and MTHFR C677T gene mutations among idiopathic VTE patients and healthy population in Zonguldak province and the Western Black Sea Region of Turkey. Methods: The present study included 157 patients with VTE and 135 healthy individuals. FVL, prothrombin G20210A and MTHFR C677T gene mutations were investigated in patients hospitalized for VTE and healthy subjects. Results: In agreement with the previously reported publications in Turkey and Europe, the prevalence of FVL, prothrombin G20210A and MTHFR C677T gene mutations were 6.7%, 2.9% and 43.7%, respectively, among healthy population. In VTE patients, it was observed that the rates of FVL, prothrombin G20210A increased significantly as well as the frequency of homozygosity for MTHFR in VTE patients was higher than controls. Conclusıon: Screening for genetic disorders such as FVL, prothrombin G20210A and MTHFR C677T gene mutations should be evaluated in patients presented with unexplained VTE. Citation: Bilici M, Corakci BD, Ozturk Y, Ertop S (2018) Commonness of Factor V Leiden, Prothrombin G20210A and Methylenetetrahydrofolate Reductase C677T Mutations among Patients with Thromboembolism in the Western Black Sea (Zonguldak) Region of Turkey. J Blood Lymph 8: 219. doi:10.4172/2165-7831.1000219

The Role of Social Networks in the Monitoring and Treatment of Adolescent Diabetes

Social media provides one way or reciprocal and simultaneous sharing of information to follow adolescent diabetes and both supply patient treatments and reduce the risk of complications. There are a variety of Internet based applications including email, chat rooms, discussion boards where questions can be sent to experts online. Responses can be given through website links, video recordings and short message services (SMS). These computer and internet based applications are varied and include a number of options. One example could be sending data from a glucose meter to a mobile phone or via the internet to a computer; diabetes education can be shared via email, mobile phone applications and video conferences. All of these media are well understood by adolescents and can be important avenues for connecting with them. Real-time monitoring helps patients and physicians follow-up blood sugar, diet and physical activities, medicine / insulin dose, psychological adjustment and problem solving. So, these technological tools can help both manage the rate of A1C type adolescent diabetes and help the patient adapt to the illness while improving the level of knowledge gained by adolescents and their families about this disease. The use of social media by medical professionals has an important role of the management of Type 1 diabetes.

Comparison of Drug-Eluting Balloon and Standard Balloon Angioplasty for Infrapopliteal Arterial Diseases in Diabetic Patients

Objective: To consider the clinical outcomes and restenosis rates of drug-eluting balloons (DEBs) and percutaneous transluminal angioplasty (PTA) in diabetic patients with infrapopliteal (IP) arterial disease. Materials and Methods: This retrospective, single-center study included 51 patients (37 males; mean age: 63.43 ± 9.81 years) with diabetes mellitus having IP arterial disease, from October 2012 to September 2014. Twenty-two patients were treated with PTA, and 29 patients were treated with DEBs. After intervention, the patients were evaluated in the first week and every 3 months, clinically and radiologically. Univariate and multivariate analyses were used to evaluate the clinical outcomes of diabetic patients with IP arterial disease who were treated with either DEBs or PTA. Results: There were no statistically significant differences between the groups in terms of age and gender, risk factors, characteristics of lesions, or the diameters or length of the balloons (P > .05). Primary patency was higher in the DEB group than in the PTA group (97.8% vs 81.1%, P = .020) in the first 3 months. However, there was no statistically significant difference at 1-year follow-up (68.2% vs 48.5%, P = .131). At the 12-month follow-up, there was no difference in clinical improvement between the groups (P = .193). Conclusion: The findings of this study reveal that DEB is a safe alternative treatment method for IP arterial disease in diabetic patients.

Does the awareness of the patient about the amount of daily salt consumption decrease his/her salt intake?

Received: 19.10.2016 accepted: 11.11.2016 1Bulent Ecevit University School of Medicine, Department of Internal Medicine 2Zonguldak Ataturk Goverment Hospital, Department of Nephrology 3Bulent Ecevit University School of Medicine, Department of Nephrology Yazışma adresi: Muammer Bilici, Bulent Ecevit University School of Medicine, Department of Internal Medicine, Zonguldak e-mail: drmbilici@hotmail.com GİrİŞ

The Adrenal Gland Volume Measurements in Manifestation of the Metabolic Status in Type-2 Diabetes Mellitus Patients

Objectives. The aim of our study was to investigate the differences in adrenal gland volume between nondiabetic controls and Type-2 diabetic patients and to examine the influence of glycemic control in diabetes mellitus on adrenal gland volume. Methods. From March 2 to November 25, 2015, 62 consecutive patients with Type-2 DM along with 62 nondiabetics matched by age, gender, and BMI were enrolled in this prospective study. Our diabetes patients were categorized into two groups, well-controlled and poorly controlled diabetes groups. Adrenal volumetric measurements were performed by two radiologists, prospectively and independently, with semiautomatic software. Interobserver reliability was studied using the interobserver correlation coefficient (ICC). Results. The total adrenal volume (TAV) was significantly higher in Type-2 diabetic patients when compared with nondiabetic patients (p < 0.05). When we investigated diabetic patients according to glycemic controls, the TAVs in controlled diabetic patients were significantly higher than in those of the poorly controlled or uncontrolled diabetic patients (p < 0.05). Nondiabetic control patients have significantly smaller TAVs when compared to controlled and poorly or noncontrolled diabetic patients (p < 0.05). Conclusion. Our study suggests that adrenal gland volume measurement may be used as an indirect marker of glycemic control in patients with diabetes.

Laparoskopik kolesistektominin nadir komplikasyonu: duodenuma klip göçü

Laparoskopik kolesistektomi sonrasi, ameliyatta kullanilan metal kliplerin duedonum duvarina hareketle cikinti olusturmalari nadir gorulen bir komplikasyondur. Genellikle kanamali ulsere neden olurlar. Klinigimize karin agrisi, hazimsizlik ve mide eksimesi sikayetiyle basvuran 65 yasinda bayan hastaya yapilan ust gastrointestinal endoskopide duedonum bulbus tabaninda yerlesik metal klip izlendi. Yapilan skopide ust uste binmis iki klip oldugu goruldu. Metal klipler endoskopik olarak cikarildi. Olgunun oykusunde 15 ay once semptomatik kolelitiazis nedeniyle laparoskopik kolesistektomi yapildigi ogrenildi. Bu olgu sunumunda laparoskopik kliplerlerin nadir olarak duedonum duvarina cikinti olusturmasina yonelik yaklasim ile ilgili bilgi verildi.