Oykü Tayfur - Academia.edu (original) (raw)

Papers by Oykü Tayfur

Research paper thumbnail of Association between serum vitamin D and parathyroid hormone levels in Turkish patients with colonic polyps

Acta gastro-enterologica Belgica

Epidemiological and investigational studies have proved that vitamin D is important in autoimmune... more Epidemiological and investigational studies have proved that vitamin D is important in autoimmune processes and has anticancerogenic properties. But the interplay between serum vitamin D and parathyroid hormone (PTH) in colorectal polyps has been less clearly put forward. We evaluated serum vitamin D, PTH levels in Turkish people and tried to stratify colorectal polyps according to risk factors. Patients undergoing colonoscopy between January 2012 and March 2012 were considered to study serum vitamin D levels during winter. Study population comprised of 98 colorectal polyp and 197 normal colonoscopy patients. Serum vitamin D levels were not different between the groups (mean vitamin D level in polyp group 14.3 ± 11.1 vs. 12.7 ± 6.74 the normal group, p = 0.12). Likewise serum PTH levels were not different between the groups Patients with polyps were further classified as high and low risk polyps. When discriminant function analysis was conducted, the effects of vitamin D or PTH leve...

Research paper thumbnail of ERCP in patients with Jaboulay pyloroplasty

Acta gastro-enterologica Belgica, 2012

Research paper thumbnail of Arterial thromboembolic complications may be more common than expected in inflammatory bowel diseases

Journal of Crohn's and Colitis, 2014

Research paper thumbnail of Tuberculous bursitis of the greater trochanter mimicking ankylosing spondylitis

European Journal of Rheumatology, 2014

Research paper thumbnail of A novel finding in MNGIE (Mitochondrial Neurogastrointestinal Encephalomyopathy): hypergonadotropic hypogonadism

Research paper thumbnail of A fortuitous episode of brachial plexopathy in a patient with metastatic breast cancer

Surgical Neurology, 2008

A 42-year-old lady, with a known diagnosis of metastatic breast cancer, was seen in the oncology ... more A 42-year-old lady, with a known diagnosis of metastatic breast cancer, was seen in the oncology ward for weakness in her left hand for the last 4 to 5 days. She described the episode as having emerged the morning after a long sleep on her left shoulder. Thereafter, she could only move her left upper limb with the aid of her right hand. The current medical history was otherwise noncontributory, and in fact, she was hospitalized for routine chemotherapy, but her complaint was only coincidental.

Research paper thumbnail of Endoscopic Treatment of Biliary Fistulas Developing After Liver Resections

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2013

Bile leaks are a major cause of mortality and morbidity after liver resections. We prospectively ... more Bile leaks are a major cause of mortality and morbidity after liver resections. We prospectively evaluated the safety and efficacy of endoscopic treatment of biliary fistulas developing after liver resections in 15 patients. Fistulas developed after extended right hepatectomy in 4, extended left hepatectomy in 8, and segmentectomy in 3 patients. Median time interval between surgery and endoscopic intervention was 10 days (range, 7 to 35 d). Endoscopic sphincterotomy followed by a nasobiliary drain insertion was the initial treatment. If the fistula persisted after 2 weeks, nasobiliary drain was replaced by a plastic stent. The effect of output (low in 10 and high in 5 patients) and the origin of fistula (stump in 10 and resection surface of the liver in 5 patients) on the time for closure were evaluated. Bile leakage ceased by only nasobiliary drainage catheter placement in 11 patients (73.3%). Plastic stents were inserted in 4 patients. There was a significant correlation between the output of bile leakage and the time needed for fistula closure. Endoscopic treatment methods are effective in patients with bile leaks due to liver resections.

Research paper thumbnail of Impact of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs on hospital outcomes in patients with peptic ulcer bleeding

Saudi Journal of Gastroenterology, 2014

There are a limited number of studies including the impact of antiplatelet drugs use on hospital ... more There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding. The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients. In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038). Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding.

Research paper thumbnail of Accuracy of endoscopic ultrasound-guided fine needle aspiration cytology on the differentiation of malignant and benign pancreatic cystic lesions: A single-center experience

Journal of Digestive Diseases, 2013

The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) i... more The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in cytology and the biochemical analysis of cyst fluid, together with the size of the lesion in the differentiation between benign and malignant pancreatic cystic lesions. Data of patients who underwent EUS-FNA for pancreatic cystic lesions in our center from January 2006 to October 2010 were retrospectively analyzed. The diagnostic accuracy of EUS-FNA was determined. Of the 56 patients, 37 (66.1%) had evaluable cytology for diagnosis and sufficient cyst fluid was available for biochemical analysis in 58.9% (33/56) of the patients. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA for detecting malignancy were 63%, 100%, 100% and 85%, respectively. EUS-FNA was the most accurate diagnostic method for differentiating malignant and benign pancreatic cystic lesions (88%). Cyst fluid carcinoembryonic antigen (CEA) > 365 ng/mL had a sensitivity of 100% for the detection of malignant cystic lesions. Although the rate of insufficient cyst fluid aspiration is high, the combination of cytological evaluation and CEA analysis of cyst fluid obtained by EUS-FNA is accurate in differentiating malignant cystic lesions from benign ones. Safe techniques are essential to improve the yield of cyst fluid aspiration by EUS.

Research paper thumbnail of Endoscopic removal of an immigrant ( Taenia saginata ) from the stomach of a geriatric patient

Geriatrics & Gerontology International, 2013

Research paper thumbnail of Presence and diagnosis of amebic infestation in Turkish patients with active ulcerative colitis

European Journal of Internal Medicine, 2009

It is difficult to definitively diagnose acute amebiasis, particularly when this condition is sup... more It is difficult to definitively diagnose acute amebiasis, particularly when this condition is superimposed on inflammatory bowel disease. Our goals in this study were to determine the prevalence of amebiasis in individuals with active ulcerative colitis, and to identify clinical and laboratory parameters that are of value for diagnosing amebiasis in this patient group. The subjects were 111 patients (76 women, 35 men) with confirmed active ulcerative colitis who attended our hospital's Inflammatory Bowel Disease Outpatient Clinic between May 2002 and March 2006. In each case, a detailed medical history was collected, blood samples were tested for inflammatory markers, and stool samples were evaluated for presence of amebae using an Enzyme-Linked Immunosorbent Assay (ELISA) for detection of Entamoeba histolytica antigen. The clinical and laboratory variables for the ELISA-positive and ELISA-negative groups were compared. Amebiasis was detected in 35 (31.5%) of the subjects. Patient age, disease duration, endoscopic activity index, serum C-reactive protein level, and white blood cell count were not useful for diagnosing amebiasis in this patient group. Given the high rate of amebiasis observed in our patients with active ulcerative colitis, we recommend that, in Turkey any individual with ulcerative colitis who presents with symptoms of disease activation should be tested for ameba using antigen detection kits. A high index of suspicion is especially important in any region where E. histolytica is endemic.

Research paper thumbnail of Ectopic varices in portal hypertension

European Journal of Gastroenterology & Hepatology, 2011

Ectopic varices (EcV) accounting for 1-5% of all varices in portal hypertension are composed of d... more Ectopic varices (EcV) accounting for 1-5% of all varices in portal hypertension are composed of dilated portosystemic collaterals located in unusual sites instead of the most known gastroesophageal region. The difficulty in localization of bleeding is a great burden on the management of these patients. Herein, we present patients with EcV as well as with portal hypertension and recurrent intestinal bleeding. The sites of EcV were identified with computed tomographic angiography, after a series of inconclusive endoscopies, and moreover a selective celiac arteriographic examination of one of the patients.

Research paper thumbnail of White Coat Effect and Its Clinical Implications in the Elderly

Clinical and Experimental Hypertension, 2009

The aim of this study was to investigate the frequency and correlated factors of white coat effec... more The aim of this study was to investigate the frequency and correlated factors of white coat effect (WCE) in the elderly. Geriatric patients who were known as normotensive and office BP exceeding 140/90 mmHg underwent 24-hour ambulatory blood pressure monitoring (ABPM). Correlation of WCE with clinical parameters, geriatric assessment scales, co-existing diseases, and laboratory results were analyzed. Within 61 patients 72.1% were diagnosed as white coat hypertension (WCH). Independent correlates of systolic WCE were activities of daily living, instrumental activities of daily living scores, creatinine; independent correlate of diastolic WCE was Geriatric Depression Scale score. White coat hypertension constitutes a major part of office-detected hypertension in geriatric patients. Ambulatory blood pressure monitoring should be performed on geriatric patients with office-measured hypertension in order to avoid overtreatment.

Research paper thumbnail of Alterations of von Willebrand Factor and Ristocetin Cofactor Activity During Atrial Fibrillation

Clinical and Applied Thrombosis/Hemostasis, 2007

The aim of this study was to assess the plasma levels of von Willebrand factor antigen and ristoc... more The aim of this study was to assess the plasma levels of von Willebrand factor antigen and ristocetin cofactor activity, which are well-known markers of endothelial function, in atrial fibrillation (AF) with or without mitral stenosis (MS). Forty-two patients (16 patients with MS and AF [MS(+)AF(+)], 13 patients with nonvalvular AF [MS(-)AF(+)], and 13 patients with MS and sinus rhythm [MS(+)AF(-)]) were included. Von Willebrand factor antigen levels and ristocetin cofactor activities in all participants were assessed. Overall, von Willebrand factor antigen levels and ristocetin cofactor activities in the AF(+) patients were higher than in the AF(-) patients (P = .003 and P = .002, respectively). Von Willebrand factor antigen levels and ristocetin cofactor activities in the 3 groups were found to be different (P = .012 and P = .01, respectively). Von Willebrand factor antigen levels were similar between the MS(+)AF(+) and MS(-)AF(+) groups and were higher than that of the MS(+)AF(-) group. Ristocetin cofactor activity in the MS(-)AF(+) group was significantly higher than in the other 2 groups. The ristocetin cofactor activity and von Willebrand factor antigen levels were significantly higher in diabetic or hypertensive patients than in nondiabetic or normotensive patients. According to the results of this study, circulating von Willebrand factor antigen levels and plasma ristocetin cofactor activities are affected by the presence of AF, MS, and associated comorbidities including type 2 diabetes mellitus and systemic hypertension. Further studies are needed to assess the role of von Willebrand factor antigen and ristocetin cofactor activity in predicting vascular thrombotic events in AF, MS, systemic hypertension, and diabetes mellitus.

Research paper thumbnail of Insulin resistance and metabolic syndrome in prepubertal boys with Klinefelter syndrome

Acta Paediatrica, 2011

Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases... more Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases sharing the same factor in their pathogenesis; insulin resistance. The aim of the study was to establish a link between glucose tolerance and NAFLD. Fifty-two non-diabetic NAFLD patients were included in the study. Inclusion criteria were elevated alanine aminotransferase (ALT), hyperechogenic liver detected at ultrasonography, and exclusion of other causes of liver disease. Hepatobiliary ultrasonography and laboratory tests including biochemical and metabolic profiles were performed; HOMA insulin resistance was calculated. The mean age was 43 years, and 61% were male. More than a two fold increase in alanine aminotransferase levels was seen in 37% of the patients. Serum levels of aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase (ALP) were elevated in 36%, 46%, and 30% of patients respectively. Low HDL-C levels were found in 46% and high LDL-C levels in 25%. Other results of note were elevated lipoprotein-a levels in 40%, impaired fasting glucose in 23%, impaired glucose tolerance in 26%, elevated fasting c-peptide levels in 61%, and elevated fasting serum insulin levels in 11% of patients. In 30% of patients, body mass index was over 30 kg/m2 and 78% had a waist-hip ratio more than 0.9. HOMA insulin resistance was significantly related with elevated ALP levels and hepatomegaly. Following a 6 months treatment with a standard diet, liver enzymes and metabolic parameters both improved. Only 7 patients had persistently high liver enzymes. Basal insulin levels and the oral glucose tolerance test should be an integral part of the evaluation of patients with NAFLD. The association between NAFLD and metabolic syndrome as well as the benefits of dieting on preventing progression of NAFLD should be stressed.

Research paper thumbnail of Twice a day quadruple therapy for the first-line treatment of Helicobacter pylori in an area with a high prevalence of background antibiotic resistance

Acta gastro-enterologica Belgica, 2013

Bismuth-containing quadruple therapy given four times a day is effective in the first-line treatm... more Bismuth-containing quadruple therapy given four times a day is effective in the first-line treatment of Helicobacter pylori. We aimed to investigate whether twice daily posology could eradicate H. pylori at a comparable rate in an area with a high prevalence of antibiotic resistance. The study group consisted of 90 patients with treatment naïve H. pylori. Patients were randomized to BOMT1 group (Bismuth citrate 2 x 600 mg, omeprazole 2 x 20 mg, metronidazole 2 x 500 mg, tetracycline 2 x 500 mg; for 14 days) and BOMT2 group (Bismuth citrate 2 x 600 mg, omeprazole 2 x 20 mg, metronidazole 3 x 500 mg, tetracycline 4 x 500 mg; for 14 days). H. pylori eradication was assessed by both C14-urea breath test and stool antigen test at least 8 weeks after treatment. Demographic characteristics and endoscopy findings of the groups were similar. Eighty-two patients completed the study (BOMT1= 38 and BOMT2 = 44) including H. pylori eradication assessment. The eradication rates determined by PP an...

Research paper thumbnail of Association between serum vitamin D and parathyroid hormone levels in Turkish patients with colonic polyps

Acta gastro-enterologica Belgica

Epidemiological and investigational studies have proved that vitamin D is important in autoimmune... more Epidemiological and investigational studies have proved that vitamin D is important in autoimmune processes and has anticancerogenic properties. But the interplay between serum vitamin D and parathyroid hormone (PTH) in colorectal polyps has been less clearly put forward. We evaluated serum vitamin D, PTH levels in Turkish people and tried to stratify colorectal polyps according to risk factors. Patients undergoing colonoscopy between January 2012 and March 2012 were considered to study serum vitamin D levels during winter. Study population comprised of 98 colorectal polyp and 197 normal colonoscopy patients. Serum vitamin D levels were not different between the groups (mean vitamin D level in polyp group 14.3 ± 11.1 vs. 12.7 ± 6.74 the normal group, p = 0.12). Likewise serum PTH levels were not different between the groups Patients with polyps were further classified as high and low risk polyps. When discriminant function analysis was conducted, the effects of vitamin D or PTH leve...

Research paper thumbnail of ERCP in patients with Jaboulay pyloroplasty

Acta gastro-enterologica Belgica, 2012

Research paper thumbnail of Arterial thromboembolic complications may be more common than expected in inflammatory bowel diseases

Journal of Crohn's and Colitis, 2014

Research paper thumbnail of Tuberculous bursitis of the greater trochanter mimicking ankylosing spondylitis

European Journal of Rheumatology, 2014

Research paper thumbnail of A novel finding in MNGIE (Mitochondrial Neurogastrointestinal Encephalomyopathy): hypergonadotropic hypogonadism

Research paper thumbnail of A fortuitous episode of brachial plexopathy in a patient with metastatic breast cancer

Surgical Neurology, 2008

A 42-year-old lady, with a known diagnosis of metastatic breast cancer, was seen in the oncology ... more A 42-year-old lady, with a known diagnosis of metastatic breast cancer, was seen in the oncology ward for weakness in her left hand for the last 4 to 5 days. She described the episode as having emerged the morning after a long sleep on her left shoulder. Thereafter, she could only move her left upper limb with the aid of her right hand. The current medical history was otherwise noncontributory, and in fact, she was hospitalized for routine chemotherapy, but her complaint was only coincidental.

Research paper thumbnail of Endoscopic Treatment of Biliary Fistulas Developing After Liver Resections

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2013

Bile leaks are a major cause of mortality and morbidity after liver resections. We prospectively ... more Bile leaks are a major cause of mortality and morbidity after liver resections. We prospectively evaluated the safety and efficacy of endoscopic treatment of biliary fistulas developing after liver resections in 15 patients. Fistulas developed after extended right hepatectomy in 4, extended left hepatectomy in 8, and segmentectomy in 3 patients. Median time interval between surgery and endoscopic intervention was 10 days (range, 7 to 35 d). Endoscopic sphincterotomy followed by a nasobiliary drain insertion was the initial treatment. If the fistula persisted after 2 weeks, nasobiliary drain was replaced by a plastic stent. The effect of output (low in 10 and high in 5 patients) and the origin of fistula (stump in 10 and resection surface of the liver in 5 patients) on the time for closure were evaluated. Bile leakage ceased by only nasobiliary drainage catheter placement in 11 patients (73.3%). Plastic stents were inserted in 4 patients. There was a significant correlation between the output of bile leakage and the time needed for fistula closure. Endoscopic treatment methods are effective in patients with bile leaks due to liver resections.

Research paper thumbnail of Impact of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs on hospital outcomes in patients with peptic ulcer bleeding

Saudi Journal of Gastroenterology, 2014

There are a limited number of studies including the impact of antiplatelet drugs use on hospital ... more There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding. The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients. In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038). Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding.

Research paper thumbnail of Accuracy of endoscopic ultrasound-guided fine needle aspiration cytology on the differentiation of malignant and benign pancreatic cystic lesions: A single-center experience

Journal of Digestive Diseases, 2013

The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) i... more The aim was to compare the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in cytology and the biochemical analysis of cyst fluid, together with the size of the lesion in the differentiation between benign and malignant pancreatic cystic lesions. Data of patients who underwent EUS-FNA for pancreatic cystic lesions in our center from January 2006 to October 2010 were retrospectively analyzed. The diagnostic accuracy of EUS-FNA was determined. Of the 56 patients, 37 (66.1%) had evaluable cytology for diagnosis and sufficient cyst fluid was available for biochemical analysis in 58.9% (33/56) of the patients. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNA for detecting malignancy were 63%, 100%, 100% and 85%, respectively. EUS-FNA was the most accurate diagnostic method for differentiating malignant and benign pancreatic cystic lesions (88%). Cyst fluid carcinoembryonic antigen (CEA) > 365 ng/mL had a sensitivity of 100% for the detection of malignant cystic lesions. Although the rate of insufficient cyst fluid aspiration is high, the combination of cytological evaluation and CEA analysis of cyst fluid obtained by EUS-FNA is accurate in differentiating malignant cystic lesions from benign ones. Safe techniques are essential to improve the yield of cyst fluid aspiration by EUS.

Research paper thumbnail of Endoscopic removal of an immigrant ( Taenia saginata ) from the stomach of a geriatric patient

Geriatrics & Gerontology International, 2013

Research paper thumbnail of Presence and diagnosis of amebic infestation in Turkish patients with active ulcerative colitis

European Journal of Internal Medicine, 2009

It is difficult to definitively diagnose acute amebiasis, particularly when this condition is sup... more It is difficult to definitively diagnose acute amebiasis, particularly when this condition is superimposed on inflammatory bowel disease. Our goals in this study were to determine the prevalence of amebiasis in individuals with active ulcerative colitis, and to identify clinical and laboratory parameters that are of value for diagnosing amebiasis in this patient group. The subjects were 111 patients (76 women, 35 men) with confirmed active ulcerative colitis who attended our hospital's Inflammatory Bowel Disease Outpatient Clinic between May 2002 and March 2006. In each case, a detailed medical history was collected, blood samples were tested for inflammatory markers, and stool samples were evaluated for presence of amebae using an Enzyme-Linked Immunosorbent Assay (ELISA) for detection of Entamoeba histolytica antigen. The clinical and laboratory variables for the ELISA-positive and ELISA-negative groups were compared. Amebiasis was detected in 35 (31.5%) of the subjects. Patient age, disease duration, endoscopic activity index, serum C-reactive protein level, and white blood cell count were not useful for diagnosing amebiasis in this patient group. Given the high rate of amebiasis observed in our patients with active ulcerative colitis, we recommend that, in Turkey any individual with ulcerative colitis who presents with symptoms of disease activation should be tested for ameba using antigen detection kits. A high index of suspicion is especially important in any region where E. histolytica is endemic.

Research paper thumbnail of Ectopic varices in portal hypertension

European Journal of Gastroenterology & Hepatology, 2011

Ectopic varices (EcV) accounting for 1-5% of all varices in portal hypertension are composed of d... more Ectopic varices (EcV) accounting for 1-5% of all varices in portal hypertension are composed of dilated portosystemic collaterals located in unusual sites instead of the most known gastroesophageal region. The difficulty in localization of bleeding is a great burden on the management of these patients. Herein, we present patients with EcV as well as with portal hypertension and recurrent intestinal bleeding. The sites of EcV were identified with computed tomographic angiography, after a series of inconclusive endoscopies, and moreover a selective celiac arteriographic examination of one of the patients.

Research paper thumbnail of White Coat Effect and Its Clinical Implications in the Elderly

Clinical and Experimental Hypertension, 2009

The aim of this study was to investigate the frequency and correlated factors of white coat effec... more The aim of this study was to investigate the frequency and correlated factors of white coat effect (WCE) in the elderly. Geriatric patients who were known as normotensive and office BP exceeding 140/90 mmHg underwent 24-hour ambulatory blood pressure monitoring (ABPM). Correlation of WCE with clinical parameters, geriatric assessment scales, co-existing diseases, and laboratory results were analyzed. Within 61 patients 72.1% were diagnosed as white coat hypertension (WCH). Independent correlates of systolic WCE were activities of daily living, instrumental activities of daily living scores, creatinine; independent correlate of diastolic WCE was Geriatric Depression Scale score. White coat hypertension constitutes a major part of office-detected hypertension in geriatric patients. Ambulatory blood pressure monitoring should be performed on geriatric patients with office-measured hypertension in order to avoid overtreatment.

Research paper thumbnail of Alterations of von Willebrand Factor and Ristocetin Cofactor Activity During Atrial Fibrillation

Clinical and Applied Thrombosis/Hemostasis, 2007

The aim of this study was to assess the plasma levels of von Willebrand factor antigen and ristoc... more The aim of this study was to assess the plasma levels of von Willebrand factor antigen and ristocetin cofactor activity, which are well-known markers of endothelial function, in atrial fibrillation (AF) with or without mitral stenosis (MS). Forty-two patients (16 patients with MS and AF [MS(+)AF(+)], 13 patients with nonvalvular AF [MS(-)AF(+)], and 13 patients with MS and sinus rhythm [MS(+)AF(-)]) were included. Von Willebrand factor antigen levels and ristocetin cofactor activities in all participants were assessed. Overall, von Willebrand factor antigen levels and ristocetin cofactor activities in the AF(+) patients were higher than in the AF(-) patients (P = .003 and P = .002, respectively). Von Willebrand factor antigen levels and ristocetin cofactor activities in the 3 groups were found to be different (P = .012 and P = .01, respectively). Von Willebrand factor antigen levels were similar between the MS(+)AF(+) and MS(-)AF(+) groups and were higher than that of the MS(+)AF(-) group. Ristocetin cofactor activity in the MS(-)AF(+) group was significantly higher than in the other 2 groups. The ristocetin cofactor activity and von Willebrand factor antigen levels were significantly higher in diabetic or hypertensive patients than in nondiabetic or normotensive patients. According to the results of this study, circulating von Willebrand factor antigen levels and plasma ristocetin cofactor activities are affected by the presence of AF, MS, and associated comorbidities including type 2 diabetes mellitus and systemic hypertension. Further studies are needed to assess the role of von Willebrand factor antigen and ristocetin cofactor activity in predicting vascular thrombotic events in AF, MS, systemic hypertension, and diabetes mellitus.

Research paper thumbnail of Insulin resistance and metabolic syndrome in prepubertal boys with Klinefelter syndrome

Acta Paediatrica, 2011

Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases... more Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases sharing the same factor in their pathogenesis; insulin resistance. The aim of the study was to establish a link between glucose tolerance and NAFLD. Fifty-two non-diabetic NAFLD patients were included in the study. Inclusion criteria were elevated alanine aminotransferase (ALT), hyperechogenic liver detected at ultrasonography, and exclusion of other causes of liver disease. Hepatobiliary ultrasonography and laboratory tests including biochemical and metabolic profiles were performed; HOMA insulin resistance was calculated. The mean age was 43 years, and 61% were male. More than a two fold increase in alanine aminotransferase levels was seen in 37% of the patients. Serum levels of aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase (ALP) were elevated in 36%, 46%, and 30% of patients respectively. Low HDL-C levels were found in 46% and high LDL-C levels in 25%. Other results of note were elevated lipoprotein-a levels in 40%, impaired fasting glucose in 23%, impaired glucose tolerance in 26%, elevated fasting c-peptide levels in 61%, and elevated fasting serum insulin levels in 11% of patients. In 30% of patients, body mass index was over 30 kg/m2 and 78% had a waist-hip ratio more than 0.9. HOMA insulin resistance was significantly related with elevated ALP levels and hepatomegaly. Following a 6 months treatment with a standard diet, liver enzymes and metabolic parameters both improved. Only 7 patients had persistently high liver enzymes. Basal insulin levels and the oral glucose tolerance test should be an integral part of the evaluation of patients with NAFLD. The association between NAFLD and metabolic syndrome as well as the benefits of dieting on preventing progression of NAFLD should be stressed.

Research paper thumbnail of Twice a day quadruple therapy for the first-line treatment of Helicobacter pylori in an area with a high prevalence of background antibiotic resistance

Acta gastro-enterologica Belgica, 2013

Bismuth-containing quadruple therapy given four times a day is effective in the first-line treatm... more Bismuth-containing quadruple therapy given four times a day is effective in the first-line treatment of Helicobacter pylori. We aimed to investigate whether twice daily posology could eradicate H. pylori at a comparable rate in an area with a high prevalence of antibiotic resistance. The study group consisted of 90 patients with treatment naïve H. pylori. Patients were randomized to BOMT1 group (Bismuth citrate 2 x 600 mg, omeprazole 2 x 20 mg, metronidazole 2 x 500 mg, tetracycline 2 x 500 mg; for 14 days) and BOMT2 group (Bismuth citrate 2 x 600 mg, omeprazole 2 x 20 mg, metronidazole 3 x 500 mg, tetracycline 4 x 500 mg; for 14 days). H. pylori eradication was assessed by both C14-urea breath test and stool antigen test at least 8 weeks after treatment. Demographic characteristics and endoscopy findings of the groups were similar. Eighty-two patients completed the study (BOMT1= 38 and BOMT2 = 44) including H. pylori eradication assessment. The eradication rates determined by PP an...