PubMed Health⌕ Search

Biomedical subjects

Fulya Günşar

Publications and source records attributed to Fulya Günşar.

8 recordsLinked to original sources
PubMed2006

Results of endoscopic management of anastomotic biliary strictures after orthotopic liver transplantation.

BACKGROUND/AIMS: Anastomotic biliary strictures are common biliary complications after orthotopic liver transplantation. We assessed the success of endoscopic retrograde cholangio-pancreaticography (ERCP) in the treatment and outcome of post-liver transplantation anastomotic biliary strictures in a university hospital, retrospectively. METHODS: Thirty-three ERCPs were performed in 20 of 162 adult liver transplant recipients with duct to duct anastomosis. RESULTS: In five patients, ERCP failed because the stricture could not be passed with guidewire. Four patients were treated with balloon dilatation only; two of them are recurrence-free with a follow-up of 24 and 8 months. Eleven patients had balloon dilatation and plastic stent placement as their primary treatment modality. In six of them, the anastomosis remained patent for the rest of the follow-up (22+/-13 months). Five patients had stricture recurrence after first stenting which necessitated re-stenting; four of them required a third, and three had a fourth stenting. CONCLUSIONS: Endoscopic balloon dilatation and stenting are safe and effective means of treatment of anastomotic biliary strictures following liver transplantation.

Adolescent↗
PubMed2006

Liver penetration of duodenal ulcer.

Liver penetration is a rare complication of peptic ulcer disease. Histopathological examination of endoscopic biopsy is essential for diagnosis as well as sonographic and computerized tomography imaging. Endoscopic examination could not exclude tumor without pathologic examination. Herein, we report a patient diagnosed as duodenal ulcer penetration into liver by endoscopic biopsy.

Adult↗
PubMed2005

Management of fatty liver disease with vitamin E and C compared to ursodeoxycholic acid treatment.

BACKGROUND/AIMS: Despite a proposed role of oxidative stress in the pathogenesis of nonalcoholic steatohepatitis, antioxidant approaches have not been investigated sufficiently in the therapy of nonalcoholic steatohepatitis. Our aim was to determine whether vitamin E plus C therapy is effective in normalization of liver enzymes compared to ursodeoxycholic acid treatment in patients with fatty liver disease. METHODS: This was an open-labeled, prospective, randomized study enrolling patients with histologically proven fatty liver disease who had chronically elevated alanine aminotransferase, despite a three-month reducing diet. Patients consuming alcohol (more than 20 g/day) were excluded. The patients were randomly prescribed either oral vitamin E (600 IU/day) plus vitamin C (500 mg/day) or ursodeoxycholic acid (10 mg/kg/day). Patients were randomized as two groups to receive vitamin E plus vitamin C combination (28 patients, 10 F) or ursodeoxycholic acid treatment (29 patients, 13 F). RESULTS: There was no significant change in body mass index before and after the treatment in both groups. At the end of six months of therapy, serum aspartate aminotransferase and aminotransferase levels significantly decreased in both treatment options. Vitamin E and C combination was more efficacious on serum aminotransferase levels than ursodeoxycholic acid, but the difference was not significant. Alanine aminotransferase decreased to normal levels in 17 of 27 (63%) and in 16 of 29 patients (55%), respectively, in the two groups. Gamma-glutamyl transpeptidase decreased in patients receiving ursodeoxycholic acid, but no change was obtained in the vitamin-treated patients. CONCLUSIONS: Vitamin E plus C combination treatment is a safe, inexpensive and effective treatment option in patients with fatty liver disease, with results comparable to those obtained with ursodeoxycholic acid. Since more effective new therapeutic options are lacking, patients with fatty liver disease should be encouraged to take vitamin E and C supplements, which are safe and affordable.

Administration, Oral↗
PubMed2005

Common variable immunodeficiency (CVID) presenting with malabsorption due to giardiasis.

Common variable immunodeficiency is characterized with B-cell and T-cell dysfunction and hypogammaglobulinemia. Recurrent bacterial infections, such as otitis media, chronic sinusitis and recurrent pneumonia due to diminished immunoglobulin (Ig) levels and impaired antibody production are frequently observed in common variable immunodeficiency. Almost half of the patients with common variable immunodeficiency have problems related to the gastrointestinal system. A 39-year-old woman was referred to our department with the complaint of chronic diarrhea. She had experienced diarrhea without mucus or blood in the last year and had lost 30 kg. In her medical history, she had suffered from recurrent upper and lower respiratory infections like sinusitis, otitis media and pneumonia since childhood. Serum immunoglobulin levels were low. There were no parasites or ova in her stool examinations. Esophagogastroduodenoscopy detected widespread macroscopic nodular appearance on duodenum, and biopsies from the duodenum revealed giardiasis invading the tissue. She was diagnosed as common variable immunodeficiency. After metronidazole therapy and intravenous immunoglobulin infusion was started, her diarrhea attacks ceased and she regained her normal weight. Common gastrointestinal system problems in patients with common variable immunodeficiency are lactose intolerance, lymphoid hyperplasia/diffuse lymphoid infiltration, loss of villi and infection, especially with Giardia lamblia. Giardiasis may lead to severe mucosal flattening and sometimes to lymphoid hyperplasia at the lamina propria of the duodenum. Medical history should be evaluated carefully regarding recurrent respiratory infections. In such cases with chronic diarrhea, common variable immunodeficiency should be kept in mind as a possible cause.

Adult↗
PubMed2004

Value of endoscopic ultrasonography for upper gastrointestinal stromal tumors: a single center experience.

BACKGROUND/AIMS: Gastrointestinal stromal tumors are the rarely seen tumors of the gastrointestinal tract. The aim of the present study was to review the patients diagnosed as upper gastrointestinal stromal tumor by endoscopic ultrasonography. METHODS: Twenty-five patients diagnosed as upper gastrointestinal stromal tumor, between 1999 and 2004, were reviewed retrospectively. RESULTS: The reason for performing upper gastrointestinal system endoscopy was nonspecific upper gastrointestinal system symptoms in most (76%) of the patients. The other causes were upper gastrointestinal bleeding and dysphagia in 16% and 8% of the cases, respectively. Lesions were located in the stomach in 17 (68%), in the esophagus in six (24%), and in the duodenum in two (8%) patients. Endoscopic ultrasonographic evaluation revealed that all of the lesions arose from the muscularis propria. In 18 (72%) patients, tumors were less than 3 cm in diameter, homogeneous and hypoechoic in appearance with regular borders, concordant with benign tumor. In five (20%) patients, lesions had heterogeneous echoic appearance with anechoic spaces, two of which were larger than 3 cm and also showed irregular borders, suggesting malignancy. Surgical therapy was performed in five (20%) patients because of upper gastrointestinal bleeding or suspicion of malignancy by endoscopic ultrasonographic evaluation. Histopathological examination confirmed the diagnosis in all these patients. CONCLUSIONS: Endoscopic ultrasonographic evaluation is very useful in diagnosis and for choosing the therapeutic method for patients with upper gastrointestinal stromal tumor.

Adult↗
PubMed2003

Interferon re-treatment for resistance to lamivudine plus interferon treatment.

BACKGROUND/AIMS: The most important problem of the lamivudine therapy is the frequent development of drug resistance. Treatment of chronic hepatitis B patients resistant to lamivudin remains to be established. We investigated in this study the efficacy of interferon therapy for breakthrough infection to combination therapy with interferon and lamivudine. METHODS: Interferon therapy was applied to nine patients who experienced HBV DNA breakthrough with ALT elevation for at least three months during the lamivudine treatment, which was given in combination with interferon for the first six months. These patients were compared with 10 patients who developed breakthrough but were not given interferon. All the patients continued to receive lamivudine. RESULTS: Of the nine patients who were given interferon, two lost HBV DNA and had normal ALT after six months of treatment. ALT levels returned to normal in two patients who had no virological response. Of those patients not given interferon, none lost HBV DNA, but three had normal ALT at the end of the same duration of follow-up. CONCLUSIONS: The patients with breakthrough infection during lamivudine treatment, which was combined with interferon at the beginning, may benefit from another cycle of interferon treatment.

Adolescent↗
PubMed2002

Risk factors associated with changes in oxygenation and pulse rate during colonoscopy.

BACKGROUND/AIMS: Although hypoxemia is a relatively common complication of colonoscoy, the possible predictive factors of oxygen desaturation and tachycardia in patients undergoing this procedure are not well known. In this study, the possible predictive factors of severe oxygen desaturation (SaO2<90%) and tachycardia in patients with undergoing colonoscopy were investigated. METHODS: A total of 79 consecutive patients were evaluated in the study (46 men and 33 women). Significant oxygen desaturation was considered to be a reduction of arterial oxygen saturation (SaO2) to less than 90%. Tachycardia was defined as a heart rate above 100/min. Patients with inadequate colonoscopy were excluded from the study. The incidence of arterial hemoglobin oxygen desaturation and changes of heart rate during colonoscopy were evaluated and clinical factors in relation to these findings were assessed. RESULTS: The SaO2 during colonoscopy fell below 90% in 19 of the 79 patients (24.1%). The risk factors for desaturation were advanced (>60yr) age (OR: 6.03; 95% CI, 1.35-26.99), receiving sedation (OR: 11.42; 95% CI, 2.05-63.49), chronic lung disease (OR: 4.54; 95% CI and 1.40-11.68), and obesity (OR: 8.95; 95% CI, 1.17-68.55). The presence of hypertension and anemia, a history of cigarette smoking and duration of the colonoscopy had no significant effect on arterial oxygen desaturation (p>0.05). The pulse rate was raised above 100/min during colonoscopy in 26 of 79 patients (32.9%). lncrease in heart rate was found to be related to arterial oxygen desaturation (OR: 13.72; 95% CI, 2.67-70.32), anemia (OR:6.17; 95% CI, 1.15-32.91) and advanced (>60 yr) age (OR: 6.08; 95% CI, 1.62-22.81). Gender, sedation, obesity, hypertension, chronic lung disease and smoking did not affect the heart rate (p>0.05). Two patients had transitional bradyarrythmia, which had no relationship with the parameters studied. There was no incidence of significant hypoxia or change in heart rate which might have caused termination of the procedure. CONCLUSIONS: Benign and transient arterial oxygen desaturation and tachycardia may occur during colonoscopy procedure. Sedation, obesity, advanced age and chronic lung disease might contribute to these adverse events.

Journal Article↗