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Öğe A novel non-invasive score for the prediction of advanced fibrosis in patients with chronic hepatitis B(Elsevier Espana, 2022) Okdemir, Sannur; Cakmak, ErolIntroduction and objectives: Evaluation of liver fibrosis is important for treatment decisions, complications and to predict prognosis in patients with chronic hepatitis B (CHB). Our aim was to develop a new non-invasive fibrosis scoring method and prove its accuracy in the differentiation of no/low grade and advanced fibrosis in patients with CHB. Patients and methods: Our study included 273 chronic hepatitis B patients who underwent liver biopsy from February, 2007 to February, 2019 with medical records retrospectively reviewed. Preparations of these patients were divided into two groups as <= 3 no-low grade fibrosis (n=236) and >= 4 advanced fibrosis (n=37) according to histological ISHAK fibrosis scoring system. Results: The newly developed AGAP score and other non-invasive fibrosis scores; Fibrosis-4 index, Aspartate aminotransferase to platelets ratio, Gamma glutamyl transpeptidase to platelet ratio, Goteborg University Cirrhosis Index, King's score, Albumin-bilirubin index, Fibrosis cirrhosis index, Fibrosis index, Fibrosis quotient, Lok score and mean and/or median values of Fibroindex were significantly higher in the advanced fibrosis group compared to the no/low grade fibrosis group (p<0.001). However, there was no significant difference in AAR score among the groups (p=0.265). With cut-off value of 4.038, AUROC value of 0.803, sensitivity of 75.7%, specificity of 73.7% and accuracy of 0.740, AGAP score showed the best performance in advanced fibrosis differentiation compared to 12 other non-invasive fibrosis scoring methods. Conclusions: The newly developed AGAP score showed better performance in patients with CHB compared to 12 other non-invasive fibrosis scores in differentiation of no/low grade fibrosis and advanced fibrosis. (c) 2021 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Öğe Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage(KOWSAR PUBL, 2015) Cakmak, Erol; Duksal, Faysal; Altinkaya, Engin; Acibucu, Fettah; Dogan, Omer Tamer; Yonem, Ozlem; Yilmaz, AbdulkerimBackground: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. Objectives: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia. Patients and Methods: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of <5, 5 -14, 15 - 29 and = 30 are categorized as control, mild, moderate and severe, respectively. Results: One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 +/- 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO(2) values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O-2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner. Conclusions: We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO(2) levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.Öğe Association of Nonalcoholic Fatty Liver Damage and the Degree of Nocturnal Hypoxia in Obstructive Sleep Apnea(WILEY-BLACKWELL, 2015) Cakmak, Erol; Duksal, Faysal; Altinkaya, Engin; Acibucu, Fettah; Dogan, Omer T.; Yonem, Ozlem; Yilmaz, Abdulkerim…Öğe Chanarin-Dorfman Syndrome: A comprehensive review(Wiley, 2021) Cakmak, Erol; Bagci, GokhanThe Chanarin-Dorfman syndrome (CDS) is a rare, autosomal recessively inherited genetic disease. This syndrome is associated with a decrease in the lipolysis activity in multiple tissue cells because of recessive mutations in the abhydrolase domain containing 5 (ABHD5) gene, which leads to the accumulation of lipid droplets in multiple types of cells. Major clinical symptoms in patients with CDS include ichthyosis and intracytoplasmic lipid droplets. The variability of clinical symptoms in patients with CDS depends on a large number of mutations involved. In this syndrome, liver involvement is an important cause of mortality and morbidity. This review aims to summarize the demographic characteristic, clinical symptoms, liver involvement and mutations in CDS patients in the literature to date.Öğe Endoscopic closure of a duodenal perforation secondary to a migrated biliary plastic stent using hemoclips(Aran Ediciones, S A, 2022) Cakmak, Erol[Abstract Not Available]Öğe Endoscopic closure of duodenocolic fistula by using an over-the-scope clip(Georg Thieme Verlag Kg, 2022) Cakmak, Erol[Abstract Not Available]Öğe Evaluation of platelet-to-lymphocyte ratio, red cell distribution width and neutrophil-to-lymphocyte ratio as potential biomarkers in the early detection of gastric cancer(E-CENTURY PUBLISHING CORP, 2016) Cakmak, Erol; Altinkaya, Engin; Acibucu, Fettah; Yonem, Ozlem; Yilmaz, AbdulkerimGastric cancer is the third highest malignity for cancer-related mortality worldwide. Reduction of morbidity and mortality requires early recognition and management of gastric cancer. In recent years, biomarkers reflecting the systemic inflammatory state have been used for both diagnostic and prognostic testing. Our objective was to determine whether global inflammatory markers such as platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and neutrophil-to-lymphocyte ratio (NLR) have clinical utility in the early diagnosis of gastric cancer. We included 53 individuals diagnosed as stomach cancer, and 53 healthy age-and sex-matched subjects. Preoperative clinical and pathological data as well as information on hemoglobin levels, neutrophil, lymphocyte and platelet counts were derived from the medical records of patients. A receiver-operating characteristic (ROC) curve was calculated to identify potential criteria for using these biomarkers in the diagnosis of gastric cancer. In patients with gastric cancer, PLR, RDW, and NLR were significantly elevated when compared to healthy control subjects (P < 0.001). The optimal diagnostic cut-off was 2.17 in the ROC curve analysis [area under the curve (AUC): 0.750, sensitivity: 73%, specificity: 61%] for NLR, 128 (AUC: 0.747, sensitivity: 72%, specificity: 64%) for PLR, and 14 (AUC: 0.768, sensitivity: 70%, specificity: 74%) for RDW. The present study suggests that NLR, PLR and RDW, which are easily obtained from a routine complete blood count may be useful as potential, biomarkers for determination of early diagnosis and prognosis of gastric cancerÖğe Iatrogenic pneumoscrotum after colonoscopy(TURKISH SOC GASTROENTEROLOGY, 2011) Cakmak, Erol; Koyuncu, Ayhan; Yilmaz, Abdulkerim; Yonem, Ozlem; Ataseven, Hilmi; Sarkis, Cihat…Öğe Investıgatıon about the relaxıng effects of three molecules that act ın nıtrıc oxıde / cyclıc guanosıne monophosphate pathway namely noc-18, atacıguat and zaprınast on the sheep oddı sphıncter.(Cumhuriyet Üniversitesi, 2013) Cakmak, Erol; Yonem, ÖzlemEndoskopik retrograd kolanjiopankreatografi, yan görüşlü duodenoskop kullanılarak papilladan retrograd kontrast madde verilmesi ile safra kanalları ve pankreatik kanalın görüntülenmesi işlemidir. Safra kanallarının taş ve maligniteleri olmak üzere; Oddi sfinkter disfonksiyonu, koledok kisti ve pankreas kanalı maligniteleri gibi problemlerin hem tanı hem de tedavisinde kullanılmaktadır.Endoskopik retrograd kolanjiopankreatografi invaziv bir işlem olduğundan ciddi morbidite ve mortalite nedenidir. Gerek işlem süresinin kısalmasında gerekse komplikasyon riskinin azalmasında koledok kanalına rahat kanülizasyonun sağlanması kritik bir öneme sahiptir. Bunun da yolu oddi sfinkterin gevşetilmesinden geçer.Ayrıca öyküsünde post-ERCP pankreatit, normal bilüribin seviyesi, pankreatik sfinkterotomi, kadın cinsiyet, genç yaş ve oddi sfinkteri disfonksiyonu şüphesi gibi durumların bulunduğu yüksek riskli hastalarda oddi sfinkterinin gevşemesinin sağlanması daha da fazla önem arz etmektedir.Biz bu çalışmada Oddi sfinkteri'nin kontrolünde esas rol oynayan nitrerjik nöronlarda bulunan Nitrik Oksit/cGMP yolağını araştırmayı planladık. Bu çalışmada Nitrik Oksit/cGMP yolağının üç kritik basamağına etki eden nitrik oksit donörü NOC-18, NO-bağımsız sGC aktivatörü olan ataciguat ve fosfodiesteraz tip 5 enzim inhibitörü olan zaprinast bileşiklerinin Oddi sfinkteri üzerindeki gevşetici etkilerini araştırdık ve kendi aralarında karşılaştırdık.Bu amaçla 10 adet 38-45 kilo ağırlığında erkek Anadolu Akkaraman koyunundan Oddi sfinkter halkaları hazırlandı. Oddi sfinkter halkaları, izometrik transduktör cihazı (Grass FT03, Quiney, Mass., USA) kullanılarak NOC-18, ataciguat ve zaprinast bileşiklerinin gevşetici etkileri araştırıldı.Çalışmamızda NOC-18 ve ataciguat bileşiklerinin, bir guanilat siklaz inhibitörü olan 1H-(1,2,4)oxadiazole (4,3-a)quinoxalin-1-one (ODQ) varlığında veya yokluğunda konsantrasyona bağımlı olarak oddi sfinkteri üzerinde anlamlı oranda gevşetici etkiye sahip olduğu saptandı. Oddi sfinkteri gevşetici etkileri açısından NOC-18 ile ataciguat'ın aralarında anlamlı fark saptanmadı. Zaprinast, oddi sfinkteri üzerine anlamlı oranda gevşetici etkiye sahip olduğu saptandı. Ancak NOC-18 ile ataciguatın, zaprinastla kıyaslandığında anlamlı olarak daha fazla gevşeme yaptığı saptandı. NOC-18 bileşiği ve ataciguat için elde edilen Emaks değerleri arasında anlamlı fark saptanmadı. Zaprinast'ın Emaks değeri, NOC-18 ve ataciguata göre anlamlı oranda daha düşük saptandı. Ayrıca NOC-18, ataciguat ve zaprinastın pD2 değerleri arasında anlamlı fark saptanmadı.Sonuç olarak NOC-18, ataciguat ve zaprinast bileşiklerinin koyun oddi sfinkterinde NO/cGMP yolağının çeşitli basamaklarına etki ederek sfinkter düz kaslarında istatistiksel olarak anlamlı oranda gevşeme sağladığını gösterdik. Çalışmamızda ilk kez ataciguat ve zaprinast bileşiklerinin koyun Oddi sfinkteri'nde gevşetici etkisinin olduğunu saptadık. Nitrik Oksit/cGMP yolağına etki eden NOC-18, ataciguat ve zaprinast bileşiklerinin her üçünün de klinisyenler için umut vaat ettiğini düşünmekle beraber daha etkin olmaları sebebiyle öncelikle NOC-18 ve ataciguat'la daha ileri fazda çalışmaların yapılıp verilerimizin doğrulanması gerektiğini düşünüyoruz.Öğe Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Red Blood Cell Distribution Width as New Biomarkers in Patients with Colorectal Cancer(AVES, 2017) Cakmak, Erol; Soylu, Sinan; Yonem, Ozlem; Yilmaz, AbdulkerimObjective: The incidence of colorectal cancer in developed countries has been found to increase with age. Early diagnosis and screening decrease the mortality rates in colorectal cancer. This study aimed to use inflammatory markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW)as new biomarkers for early diagnosis and screening in patients with colorectal cancer. Materials and Methods: A total of 59 patients with colorectal cancer and 59 age-and sex-matched healthy participants were included in the study. Localization, tumor node metastasis (TNM) stage, and preoperative hemoglobin levels, neutrophil counts, lymphocyte counts, platelet counts, and RDW values were obtained from medical records. Using the receiver operating characteristic (ROC) curve, the optimal cutoff levels of the biomarkers were determined. Results: NLR, PLR, and RDW were significantly higher in patients with colorectal cancer than in healthy participants (p< 0.001). According to ROC analysis, the cutoff value for NLR was 2.05 [area under the curve (AUC): 0.740, sensitivity: 78%, specificity: 66%]; the cutoff value for PLR was 130 (AUC: 0.702, sensitivity: 65%, specificity: 72%); and the cutoff value for RDW was 14 (AUC: 0.774, sensitivity: 68%, specificity: 73%). Conclusions: NLR, PLR, and RDW were found to be significantly higher in patients with colorectal cancer than in healthy participants. Therefore, it is recommended that these additional biomarkers can be used for early diagnosis and screening of colorectal cancer.Öğe A new variant of bile duct duplication with coexistence of distal cholangiocarcinoma(NATURE PUBLISHING GROUP, 2010) Kosar, Ilkay; Ataseven, Hilmi; Yonem, Ozlem; Cakmak, Erol; Ozer, Oezdemir; Ozer, Hatice; Topcu, OmerBackground. A 72-year-old hypertensive woman presented with a 2-month history of right upper quadrant abdominal pain. She had a 15-day history of jaundice, fever with chills and shivering, nausea, vomiting, weight loss and generalized pruritus. Investigations. Physical examination, laboratory evaluation, transabdominal ultrasonography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, brush cytology, laparotomy and histopathology. Diagnosis. Bile duct duplication with coexistence of distal cholangiocarcinoma. Management. En bloc resection (including the duodenum, pancreatic head and adjacent lymph nodes), hepaticojejunostomy and pylorus-saving Whipple operation.Öğe Ovarian Reserve Assessment in Celiac Patients of Reproductive Age(INT SCIENTIFIC LITERATURE, INC, 2018) Cakmak, Erol; Karakus, Savas; Demirpence, Ozlem; Coskun, Banu DemetBackground: This study aimed to investigate ovarian reserve in patients of reproductive age with Celiac disease (CD) using anti-Mullerian hormone (AMH) levels, antral follicle counts (AFCs), and ovarian volume. Material/Methods: We included into this study 46 CD female patients and 40 healthy female subjects of reproductive age, ages 18-45 years. Venous blood samples were taken from both groups on days 2-4 of the menstrual cycle, and follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E-2), prolactin (PRL), and AMH levels were measured. On the same day, AFCs and ovarian volumes were determined. Data on body mass index (BMI), gravidity/parity/abortions/alive counts, disease duration, and Marsh histological classification were recorded. Results: There were no statistically significant differences between CD and control groups in terms of mean age, BMI, or median gravidity/parity/abortions/alive counts (p>0.05). Also, there were no statistically significant differences between the 2 groups in terms of mean FSH, LH, E-2, PRL levels, right and left ovarian volumes, and median right and left ovarian AFCs (p>0.05). However, AMH level was significantly lower in the CD group (p=0.032). No statistically significant correlation was found between AMH levels and age, BMI, FSH, LH, E-2, PRL levels, right and left ovarian volumes, right and left ovarian AFCs, or Marsh histological classification using the Spearman correlation test (p>0.05). However, an inverse correlation was detected showing that AMH levels decrease with increasing CD duration (r=-0.054, p=0.001). Conclusions: We found that AMH level and ovarian reserve was decreased in CD patients of reproductive age compared to healthy controls, and that AMH level and ovarian reserve decreased with increasing disease duration in CD patients.Öğe Paraneoplastic hyperbilirubinemia in metastatic prostate cancer and review of the current literature(AVES, 2019) Gokcen, Pinar; Gokcen, Kaan; Cakmak, Erol; Gokce, GokhanParaneoplastic syndromes are functional clinical disorders caused by the direct effect of the primary tumor or metastasis. The initial presenting symptom of the patients may be associated with paraneoplastic manifestations. Paraneoplastic cholestasis is most frequently defined in association with renal cell carcinoma (Stauffer's syndrome), but it is an extremely rare clinical entity seen in association with prostate cancer. Etiology of cholestasis was investigated in the case diagnosed as metastatic prostate cancer who applied to the gastroenterology outpatient clinic due to complaints of ascites and jaundice that established the diagnosis of paraneoplastic hyperbilirubinemia. We observed improvement of his cholestasis with hormonotherapy used for prostate cancer.Öğe A rare cause of bleeding esophageal varices: Alstrom syndrome(ELSEVIER MASSON, 2012) Cakmak, Erol; Acibucu, Duygu Oguz; Yonem, Ozlem; Ataseven, Hilmi…Öğe Role of pentoxifylline and iloprost in the prevention of ischemia-reperfusion injury in an experimental model of intestine ischemia-reperfusion in rats(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2018) Abakay, Ugur; Soylu, Sinan; Goksel, Sabahattin; Sarac, Bulent; Inan, Zeynep Deniz Sahin; Cakmak, Erol; Korkmaz, Ozge; Kurt, Atilla; Genc, Husnu CagriBACKGROUND: Intestinal ischemia-reperfusion (I/R) injury can lead to multiple organ failure and death. The aim of this study was to investigate the effects of pentoxifylline and iloprost administered before reperfusion in intestinal ischemia. METHODS: In total, 25 male Wistar Albino rats weighing 250-300 g were divided into five groups each comprising five subjects: control group (n=5), sham group (n=5, no I/R), I/R group (n=5, 45 min ischemia, and 120 min reperfusion), I/R + pentoxifylline group (n=5, 45 min ischemia following intraperitoneal 50 mg/kg pentoxifylline and 120 min reperfusion), and I/R + iloprast group (n=5, 45 min ischemia followed by intraperitoneal 2 mcg/kg iloprost and 120 min reperfusion). At the end of the experiment, ileum specimens were stained using hematoxylin-eosin and histopathologically evaluated using the Chiu score. Isometric contraction-relaxation responses were recorded using organ baths for contraction-relaxation responses. RESULTS: Pentoxifylline provided a significant improvement in response to histopathological and contraction-relaxation responses. Although iloprost provided recovery in reperfusion injury, it was not statistically significant. CONCLUSION: Our findings demonstrate that pentoxifylline may be promising in preventing small bowel ischemia-reperfusion injury. We concluded that further clinical and experimental studies for iloprost are needed.Öğe AN UNCOMMON CAUSE OF UPPER GASTROINTESTINAL BLEEDING, BLISTER PACK DRUG(WILEY-BLACKWELL, 2011) Cakmak, Erol; Cantimur, Ahmet Taner; Yonem, Ozlem…
