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Öğe Acute Tumor Lysis Syndrome in a Small Cell Lung Cancer Case(Aves, 2005) Arbak, Peri; Bilgin, Cahit; Balbay, Oner; Bicik, ZerrinAs a result of large tumor burden, acute tumor lysis syndrome (TLS) is most often seen with lymphoproliferative disorders. An uncommon association of solid tumors and TLS also have been reported. We present a patient with metastatic lung carcinoma who developed TLS. A 58-year-old male was hospitalized for a mass in left lower lobe of lung and multiple low attenuation lesions in liver revealed by computed tomography. Liver biopsy specimen revealed metastatic small cell lung carcinoma. Cisplatin (60 mg/m(2), day1), Etoposide (120 mg/m(2), day 1,2,3) regimen was started. Biochemical parameters of the patient were in normal ranges before chemotherapy, one and two days after chemotherapy. At the seventh day of discharge from the hospital, our patient admitted to emergency department with acute renal insufficiency. Patient was recruited to hemodialysis for TLS. After 3 cycles of hemodialysis biochemical parameters were normalized. Since then etoposide regimen (100 mg/day for 14 days/monthly) was used. After 4 cycles of oral Etoposide regimen symptomatic relief and incomplete response according to chest radiograph were observed. Our case was presented with a later occurence of TLS when compared with the other cases from literature. We concluded that especially in disseminated small cell lung cancer (SCLC), clinicians must be aware of this rare but fatal complication.Öğe Anterior percutaneous renal biopsy in an extremely obese patient with severe emphysema: Case report(2003) Yazıcı, Burhan; Bicik, ZerrinThe most commonly used technique of percutaneous renal biopsy is performed by approaching posteriorly. We had to perform a kidney biopsy with an anterior approach because of an access problem posteriorly. Except for transplanted kidney biopsies we could not find a similar application utilising anterior approach in the literature. Therefore, we are reporting our experience on this case who was extremely obese and had severe emphysema.Öğe Carotid intima-media thickness and transforming growth factor levels in patients with essential hypertension(Lippincott Williams & Wilkins, 2002) Bicik, Zerrin; Gönen, Sevim; Reis, Kadriye Altok; Derici, Ülver; Armsoy, Turgay; Bali, Maria; Sindel, Şükrü[No Abstract Available]Öğe The effect of different dialysis membranes on oxidative stress and selenium status(Elsevier, 2004) Yavuz, Özlem; Bicik, Zerrin; Çınar, Yelda; Güney, Yıldız; Güler, SelverBackground: Oxidative stress is an important risk factor for the development and progression of several complications in hemodialysis patients. The aim of this study was to evaluate the effects of two different dialysis membranes on oxidative stress and selenium status. Methods: Forty long-term dialysis patients and 20 age-matched healthy controls were enrolled into our study. Serum malondialdehyde (MDA) and selenium (Se) concentrations, and glutathione peroxidase (GSH-Px) activities were determined before and after hemodialysis (HD) using a hemophan (H) or a polysulfone (PS) membrane. Results: MEA levels in the HD patients were significantly higher than those in the control group (p < 0.001). GSH-Px activity and selenium concentrations were significantly lower in HD patients compared to the control group (p < 0.001). MDA levels were significantly increased (p < 0.05); GSH-Px activity and selenium concentrations were significantly reduced (p < 0.001) in the PS membrane group compared to H membrane group after HD. Conclusions: Comparing with H membrane, PS membrane caused more oxidative stress and lower levels of Se in HD patients.Öğe Effect of verapamil sustained-release on the sympathetic nervous system response to isometric stress in patients with essential hypertension: a pilot study in Turkish patients(Excerpta Medica Inc, 2001) Bicik, Zerrin; Akcan, Yusuf; Uğur, BetülBackground: Stress and sympathetic nervous system activation play a major role in the pathogenesis of essential hypertension. Recent data suggest that the calcium channel blocker verapamil, in addition to its antihypertensive effects, can alter the level of norepinephrine released during stress. Objective: The purpose of this study was to examine the effects of verapamil sustained-release (SR) on the sympathetic nervous system response to stress in patients with essential hypertension. Methods: Patients with essential hypertension (diastolic blood pressure >90 mm Hg and systolic blood pressure >140 mm Hg) whose blood pressure was inadequately controlled or uncontrolled were enrolled in the study. Secondary hypertension was ruled out by routine biochemical, endocrine, and radiologic tests. After a 15-day washout period during which all previous antihypertensive medication was discontinued, blood pressure, heart rate, and serum norepinephrine levels were measured at rest and in response to stress (ie, isometric exercise). Patients began treatment with verapamil SR at dosages recommended in the Sixth Report of the Joint National Committee for the Prevention, Diagnosis, Evaluation, and Treatment of High Blood Pressure (240 mg/d for stage I hypertension and 480 mg/d for stage II and stage III hypertension). After 4 weeks of treatment, blood pressure, heart rate, and norepinephrine levels were measured again at rest and in response to stress. Results: Thirteen patients (9 women and 4 men) were enrolled; 9 patients completed the study. Three patients were lost to follow-up and 1 was noncompliant. Verapamil SR significantly lowered norepinephrine levels both at rest and in response to stress (P<0.01), and reduced the increase in norepinephrine levels after isometric exercise. Conclusion: These results suggest that in this small sample of Turkish patients, verapamil SR significantly diminished the sympathetic nervous system response to stress by decreasing norepinephrine levels. This property may make verapamil SR especially useful when there is a need for decreased sympathetic activity (and thereby, a reduction in oxygen consumption) as well as other antihypertensive effects, such as in patients with coronary heart disease.Öğe Effects of antithyroid medication on the flow-volume loop in patients with hyperthyroidism(2004) Arbak, Peri; Bicik, Zerrin; Şafak, Alper; Çınar, Yelda; Ülger, FüsunThis prospective study was designed to evaluate the effects of hyperthyroidism on flow-volume loops in nonasthmatic 20 patients with hyperthyroidism. Thyroid related hormones (Total T3, Total T4 and TSH), thyroid gland volumes with ultrasonography, circumference of neck values and flow-volume loops were obtained at the beginning and after three months of antithyroid treatment. Propylthiouracil treatment was followed by a statistically significant decrease in thyroid gland volume and circumference of neck (p < 0.001 and p < 0.001, respectively). The most significant result was improvement of maximum midexptratory flow rate (MMEFR) after propylthiouracil therapy for three months (p= 0.003). Increases in mean forced expiratory flow after 25% of FVC has been exhaled (FEF25), mean forced expiratory flow after 75% of FVC has been exhaled (FEF75) values were found consistent with the puerall improuement in expiratory flow parameters (p= 0.044, p= 0.072 respectively) in conclusion, we speculated that improvement of expiratory flow parameters might be the earlier changes in flow volume loops of patients who were treated with propylthiouracil for hyperthyroidism.Öğe The efficacy of cystatin c assay in the prediction of glomerular filtration rate. Is it a more reliable marker for renal failure?(Walter De Gruyter Gmbh, 2005) Bicik, Zerrin; Bahçebaşı, Talat; Kulaksızoğlu, Sevsen; Yavuz, ÖzlemWe determined the sensitivity, specificity, receiver operating characteristics and correlation between. cystatin C (cysC) and two widely used markers of renal function, creatinine clearance and serum creatinine, in 244 patients (84 diabetics, 84 hypertensive an 76 healthy subjects). Renal failure was defined as creatinine clearance of less than either 80 or 60 mL/min. Variables were evaluated for two definitions of renal failure and compared between patient groups. Correlation coefficients with cysC were -0.87 for creatinine clearance and 0.92 for creatinine in patients with hypertension; - 0.90 for creatinine clearance and 0.97 for creatinine in diabetics; and -0.61 for creatinine clearance and 0.94 for creatinine in the control group. The receiver operating characteristic curves with a cut-off value of 60 mL/min were similar for creatinine and cysC, while at 80 mL/min they were 0.626 for creatinine and 0.813 for cysC levels. We classified the patients into three groups with respect to creatinine clearance (1, > 80 mL/min; 2, 60-80 mL/min; 3, < 60 mL/min). Mean creatinine (p < 0.0001) and cysC (p < 0.0001) levels were significantly different between all the groups. Sensitivity, specificity and predictive values were higher for cysC levels, particularly in diabetics and hypertensive patients. The current study suggests that cysC is preferable for detecting temporal changes in renal function in the early stages of renal insufficiency.Öğe EVALUATION OF ANTI-BODY RESPONSE OF HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS TO HEPATITIS-B VACCINE(Istanbul Univ, Faculty Medicine, Publishing Office, 2007) Alcelik, Aytekin; Bicik, Zerrin; Bahcebasi, Talat; Acikgoz, Elif; Yildirim, Mustafa; Onder, ElifObjective: Hemodialysis patients are at higher risk for Hepatitis B virus (HBV) infection when compared with the rest of the population. Adequate antibody response (approximately 90%) is achieved when healthy individuals are immunized with HBV vaccine; however, the response is about 50% and 70% in chronic renal failure (CRF) patients. In this study, it is aimed to assess the influence of different factors and the type of renal replacement, for antibody response to double dose of recombinant HBV-vaccine in dialysis patients. Materials and methods: In this retrospective study, we included 37 patients (19 males, 18 females) who were in the schedule of hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) at the Dialysis Center of Duzce University Hospital between 2004 and 2005. The patients were administered double doses of recombinant DNA derived HBV vaccine IM for four times at 0, 1, 2, and 6 months. The patients' antibody responses were determined ated by ELISA test. Results: Six of the 37 patients (16.2%) had no response to the vaccine, while 15 patients (40.5%) had low response and 16 patients (43.2%) had complete response. There was no difference between hemodialysis patients and peritoneal dialysis patients in terms of the antibody response (p>0.05). Levels of hemoglobin, total cholesterol, triglyceride and albumin, type and duration of dialysis, and gender were not correlated with the antibody response (p>0.05). Conclusion: As a result, for dialysis patients, antibody response to the HBV-vaccine is lower than that in the healthy population and this decline in response seems to be multifactorial.Öğe Evaluation of tuberculosis in chronic renal failure(2011) Alçelik, Aytekin; Öztürk, Cihadiye Elif; Bicik, Zerrin; Behçet, Mustafa; Küükbayrak, AbdulkadirPatients with chronic renal failure (CRF) are at increased risk of tuberculosis. Most of these patients offer extrapulmonary presentation of tuberculosis (TB) (1). The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss (2). We aimed to document the clinical profile, laboratory characteristics and outcome of TB in patients who were followed up in Duzce Medical Faculty Nephrology Department.Öğe Hemodiyaliz ve ayaktan periton diyalizi hastalarının Hepatit B aşısına karşı immün yanıtlarının değerlendirilmesi(2007) Alçelik, Aytekin; Bicik, Zerrin; Bahçebaşi, Talat; Açikgöz, Elif; Yildirim, Mustafa; Önder, ElifAmaç: Hemodiyaliz hastaları, Hepatit B virüs (HBV) infeksiyonu yönünden toplumun diğer kesimlerine göre daha yüksek risk altındadır. Hepatit B aşısı ile sağlıklı insanlarda aşıya karşı yeterli antikor yanıtı (yaklaşık %90) alınırken, kronik böbrek yetmezliği (KBY) hastalarında bu oran %50–70 düzeylerinde kalmaktadır. Bu çalışmada, diyaliz hastalarında çift doz rekombinant hepatit B aşısına karşı yanıt oranlarının ve antikor oluşmasında rol olabilecek çeşitli faktörlerle renal replasman türünün etkisinin araştırılması amaçlanmıştır. Gereç ve yöntem: Bu retrospektif çalışmaya, 2004-2005 yılları arasında Düzce Üniversitesi Tıp Fakültesi Hastanesi Diyaliz Merkezi'nde hemodiyaliz ve sürekli ayaktan periton diyalizi (SAPD) programında olan 37 (19 erkek, 18 kadın) hasta dahil edilmiştir. Hastalara 0, 1, 2, ve 6. aylarda çift doz (40µg) olmak üzere toplam dört kez rekombinant DNA kökenli HBV aşısı intramusküler olarak yapılmıştır. Hastaların antikor yanıtları son doz aşılamadan bir ay sonra ELISA testi ile saptanan Anti-HBs titrasyon düzeylerine göre belirlenmiştir.Bulgular: Otuz yedi hastanın 6 (%16,2)'sında aşı yanıtı alınmazken; 15 (%40,5) hastada düşük yanıt, 16 (%43,2) hastada tam yanıt saptandı. Hemodiyaliz hastaları ile periton diyalizi hastaları arasında antikor yanıtı açısından fark saptanmadı (p>0,05). Hemoglobin, total kolesterol, trigliserit, albumin düzeyleri, diyaliz türü, diyaliz süresi ve cinsiyet ile antikor yanıtları arasında korelasyon izlenmedi (p>0,05).Sonuç: Hepatit B aşısına yanıt oranı normal popülasyona göre düşük olup yanıtsızlık nedeni multifaktöriyel gibi gözükmektedir.Öğe Kontrast madde nefropatisinin önlenmesinde dopamin kullanımı(2004) Bicik, Zerrin; Şafak, Alp Alper; Şahin, İdris; Karakuş, HayriyeAmaç : Kontrast madde nefropatisinin (KMN) literatürde çok çeşitli tanımı mevcuttur. En sık kabul gören tanımı, kontrast madde alımından 48-72 saat sonra serum kreatinin değerinde yükselme olarak kabul edilmektedir. Kontrast nefropatisi, tanısal veya girişimsel amaçlı kontrast madde kullanımı sonucu özellikle diyabetes mellitus, hipertansiyon, hipovolemi gibi risk taşıyan kişilerde görülmektedir. Çalışmamızda dopaminin. KMN proflaksisi için kullanılabilirliğini incelemeyi amaçladık. Yöntem ve gereçler : Çalışmaya Radyoloji Ünitesine başvuran kontrast kullanan 60 hasta dahil edildi. Olguların üçü uyumsuzluk nedeni ile çalışma dışı bırakıldı. Olgular iki gruba ayrıldı. Birinci gruba %5 Dext-roz solüsyonu içinde 0.2 mgr/kg/dk hızında dopamin infüzyonu yapıldı, ikinci gruba dopamin olmaksızın sadece %5 Dextroz solüsyonu aynı dozda verildi. Her iki gruba da kontrast kullanımını takiben 6 saat süre içinde verildi. Olgulardan BUN, kreatinin, ürik asit tayini için 6. ve 72. saatte kan örnekleri alındı. Bulgular: Her iki grubun sonuçları karşılaştırıldı. Ayrıca riskli olan ve olmayan gruplar da kendi arasında karşılaştırıldı. Plasma kreatinin düzeyi birinci grupta belirgin olarak yükseldi (p=0.04). Diyabetes mellitus, hipertansiyon, piyelonefrit, ürolitiyazis, konjestif kalp yetmezliği, nefrotoksik ajan kullanımı risk faktörü olarak kabul edildi. Rsik faktörleri hastaların öykülerinden belirlendi. Diyabetli, piyelonefritli ve konjestif kalp yetmezliği olan hasta sayısı subgrup analizi için yeterli sayıda değildi. Dopamin almayan hipertansif hasta grubunda serum kreatinin düzeyleri dopamin alanlara göre istatistiksel olarak anlamlı olmaya yakın derecede artmıştı (p=0.07). Nefrotoksik ilaç alım öyküsü olan ve dopamin almayan olgularda serum kreatinin düzeyi dopamin alanlara göre anlamlı derecede yüksek saptandı (p=0.02). Kontrast maddenin ürolitiyazis üzerinde etkisi görülmedi. Sonuçlar : Dopamin, KMN proflaksisinde, özellikle riskli hastalarda kullanılabilecek bir ajandır. Ancak kesin bir sonuca varabilmek için geniş serili özellikle riskli hastaları içeren çalışmalara ihtiyaç vardır.Öğe The low seropositivity of hepatitis B virus in vitiligo patients(Wiley, 2006) Akçan, Yusuf; Kavak, Ayşe; Sertbaş, Yaşar; Olut, Ali Ilgın; Korkut, Esin; Bicik, Zerrin; Kısacık, BünyaminDespite of its unknown aetiology, vitiligo may be triggeredby viral infection in a genetically predisposed host, likean autoimmune disease.Öğe Ochrobactrum anthropi endocarditis and septic shock in a patient with no prosthetic valve or rheumatic heart disease: case report and review of the literature(Natl Inst Infectious Diseases, 2006) Özdemir, Davut; Soypaçacı, Zeki; Şahin, İdris; Bicik, Zerrin; Şencan, İrfanAlthough Ochrobactrum anthropi is an opportunistic pathogen in immunocompromised patients, it is increasingly being recognized to be a causative agent in healthy hosts. In this paper, we report a case of O. anthropi endocarditis and septic shock in a patient who had no prosthetic valve or rheumatic heart disease, in contrast to previous reports.Öğe Possible Chemical Peritonitis Due to Using Cool Peritoneal Dialysate Fluid: A Case Report(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2005) Alcelik, Aytekin; Bicik, Zerrin; Albayrak, Sinan; Caliskan, SerifeSterile peritonitis have been reported dependent on some agents such as icodextrin, vancomycin, and amphotericin B. We have reported a case of sterile peritonitis which was not related with these agents. The patient who had been on continuous ambulatory peritoneal dialysis for six months developed abdominal pain after using peritoneal dialysis fluid without heating. Her complaints had started immediately after that. The patient admitted to the hospital for peritonitis and initial analysis of the dialysate revealed 2000 cell/mm(3) (PMNL). Intraperitoneal ceftazidime has been started and the patient's abdominal pain decreased immediately and subsequent analysis of the dialysate showed no cells in 24 hours after the treatment. This quick response of acute peritonitis can be related with cold usage of peritoneal dialysis fluid. Therefore, chemical peritonitis secondary to the usage of cool peritoneal dialysis might be the diagnosis in our case. In conclusion, the physical factors that effect the peritoneal membrane, such as cold usage of peritoneal dialysis fluid, should be considered in the diagnosis of culture negative peritonitis.Öğe Role of transforming growth factor-beta(2) in, and a possible transforming growth factor-beta(2) gene polymorphism as a marker of, renal dysfunction in essential hypertension: a study in Turkish patients(Elsevier Science Inc, 2005) Bicik, Zerrin; Gönen, Sevim; Bahçebaşı, Talat; Reis, Kadriye; Arınsoy, Turgay; Sindel, ŞükrüBackground: Many studies have shown that transforming growth factor (TGF)-beta has a major role in renal scarring in many renal diseases and hypertension. Objectives: The primary aim of this study was to investigate both the relationship between hypertension and serum and urinary levels of TGF-beta(2) (a more sensitive isoform for glomeruli than TGF-beta(1))), and the effects of combination therapy with perindopril + indapamide on microalbuminuria, which becomes an early indicator of hypertensive benign nephropathy, and serum and urinary TGF-beta(2) levels in patients with mild to moderate essential hypertension. In addition, we examined the possible relationship between TGF-beta(2) gene polymorphism and essential hypertension. Methods: This study was conducted at the Department of Nephrology, Medical Faculty, Gazi University, Ankara, Turkey. Patients aged >= 18 years with newly diagnosed mild to moderate essential hypertension (systolic/diastolic blood pressure [SBP/DBP] > 120/> 80 mm Hg) who had not previously received antihypertensive treatment were included in the study. Patients with stage I hypertension received perindopril 2 mg + indapamide 0.625 mg (tablet), and patients with stage 11 hypertension received perindopril 4 mg + indapamide 1.125 mg (tablet). All study drugs were given OD (morning) PO with food for 6 months. Serum and urinary TGF-beta(2) and creatinine levels and serum and urinary albumin levels were measured before and after perindopril + indapamide administration. Amplified DNA fragments of the TGF-beta(2) primer region were screened using amplification refractory mutation system polymerase chain reaction analysis, and the number of ACA repeats was confirmed by DNA sequencing. Genetic studies were performed using a commercial TGF-beta(2) kit. Results: Forty patients were enrolled in the study, and 38 patients (27 women, 11 men; mean [SD] age, 46.3 [6.5] years) completed it. SBP and DBP were significantly decreased from baseline with perindopril/indapamide (both, P < 0.001). Microalbuminuria and urinary TGF-beta(2) levels also decreased significantly from baseline (P = 0.04 and P < 0.001, respectively), whereas the serum TGF-beta(2) level did not change significantly. Three patients, all of whom were found to have TGF-beta(2) gene mutations, had increased urinary TGF-beta(2) levels despite good blood pressure control. Conclusions: The results of this study in patients with mild to moderate hypertension suggest that, despite good clinical control of blood pressure, the persistence of microalbuminuria and high urinary TGF-beta(2) levels might predict renal impairment. When treating these patients, genetic tendencies and possible polymorphisms on the TGF-beta(2) locus should be kept in mind.Öğe Safe lives biopsy in a patient with chronic hepatitis C under continuous ambulatory peritoneal dialysis treatment [9](2005) Bicik, Zerrin; Akcan, Yusuf; Korkut, Esin; Korkmaz, Uğur; Sertbaş, Yaşar; Çalışkan, ŞerifeShaanxi Province Diagnosis and Treatment Center of Kawasaki Disease/Children's Hospital of Shaanxi Provincial People's Hospital; Children's Hospital of Shanghai Jiao Tong University; Beijing Children's Hospital of Capital Medical University; Shengjing Hospital of China Medical University; Affiliated Hospital of Yan'an University; Expert Committee of Advanced Training for Pediatrician, China Maternal and Children's Health Association; General Pediatric Group of Pediatrician Branch of Chinese Medical Doctor Association; Shanghai Cooperation Organization Hospital Cooperation Alliance; Pediatric International Exchange and Cooperation Center; Editorial Board of Chinese Journal of Contemporary Pediatrics.Öğe Two successive pregnancies after ursodeoxycholic acid therapy in a previously infertile woman with antimitochondrial antibody-negative primary biliary cirrhosis(Elsevier Inc., 2005) Korkut, Esin; Kısacık, Bünyamin; Akcan, Yusuf; Belenli, Olcay; Bicik, Zerrin; Yücel, OǧuzObjective: To describe the benefit of ursodeoxycholic acid (UDCA) for the initiation and completion of a successful pregnancy in a previously infertile woman with primary biliary cirrhosis. Design: Case report. Setting: A university hospital with relevant departments. Patient(s): A 29-year-old woman with primary biliary cirrhosis and failure to conceive for 6 years. Intervention(s): Establishment of diagnosis with a liver biopsy, pretreatment of patient with UDCA before conception, and continuation of UDCA after first trimester until term. UDCA was used in the second pregnancy again after the first trimester. Main Outcome Measure(s): Achievement of a safe conception and full-term pregnancy. Result(s): Two consecutive successful pregnancies, a healthy 3,250-g male infant and a healthy 3,000-g female infant. The second conception occurred in a period without the use of UDCA, implicating a latent beneficial effect of either UDCA orthe previous pregnancy via some possible immune mechanism. Conclusion(s): Ursodeoxycholic acid could help achieve conception in infertile women with primary biliary cirrhosis. The use of UDCA after the first trimester is shown to be safe in two consecutive pregnancies. Although it cannot be conclusive, the unintentional use of UDCA in the first 20 days after conception did not result in any teratogenicity in the first child. © 2005 by American Society for Reproductive Medicine.
