Person: ŞENTÜRK, HAKAN
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Publication Open Access Report of a Case of Signet Ring Carcinoma Presenting as Gastric Mucosal Thickening: A Diagnostic Dilemma(2021-01-01T00:00:00Z) Karatoprak, Cumali; Akçakaya, Adem; Şentürk, Hakan; Çoban, Ganime; Şahin, Nurhan; Türk, Hacı Mehmet; KARATOPRAK, CUMALİ; AKÇAKAYA, ADEM; ŞENTÜRK, HAKAN; ÇOBAN, GANİME; ŞAHİN, NURHAN; TÜRK, HACI MEHMETThe number of cancer cases has been increasing worldwide. Early diagnosis and tumor resection remain as the most effective treatments for gastric cancer. However, early diagnosis is not always possible as it is frequently not possible to make treatment decisions without pathologic diagnosis in patients with clinically suspected cancer. This causes delays in diagnosing cancer. We presented a 58 years old woman with gastric signet ring cell carcinoma that could not be diagnosed despite using four different methods of stomach biopsies. We aimed to emphasize that despite the use of advanced methods, if clinical cancer in non-diagnosed cases is suspected, we should be more aggressive for early diagnosis.Publication Open Access Rate and Predictors of Endoscopic Mucosal Healing in Biologic Naive Patients with Inflammatory Bowel Disease by Azathioprine Treatment: A Real World, 10 Years- Experience from a Single Centre in Turkey.(2016-08-01T00:00:00Z) Basaranoglu, METİN; Ertan, A; Mathew, S; Senturk, H; Ala, A; Demirbag, AE; BAŞARANOĞLU, METİN; ŞENTÜRK, HAKANBackground: There is increasing evidence that endoscopic mucosal healing (EMH) is a key target in inflammatory bowel disease (IBD) therapy. However, there is limited evidence of EMH rates with conventional IBD therapy outside of Western population groups. Ai̇m: To evaluate the role of azathioprine (AZA) in inducing EMH in IBD patients. Methods: Patients with inflammatory bowel disease were evaluated in terms of endoscopic mucosal healing and the incidence of surgical interventions during the azathioprine treatment between 1995 to 2014. Results: A total of 120 inflammatory bowel disease patients were enrolled. Endoscopic mucosal healing was found in 37% patients with inflammatory bowel disease (42% in chronic ulcerative colitis and 33% in Crohn's disease). Male gender had a negative impact on the efficacy of azathioprine (P<0.05). Responder inflammatory bowel disease patients were older (age at the IBD diagnose) than the nonresponder (P<0.05). Azathioprine therapy reduced the number of the surgical interventions (P<0.05). Conclusi̇on: We showed that azathioprine therapy significantly induced endoscopic mucosal healing in biologic naïve patients with active inflammatory bowel disease as well as decreasing the surgical interventions, with negative predictive factors identified by a younger age at IBD presentation and male gender.Publication Open Access DOES GRAVES- DISEASE AFFECT ESOPHAGEAL MOTILITY?(2018-07-01) Senturk, H; Karaman, Ö; İlhan, M; Turgut, SEDA; Arabaci, E; Taşan, E; TURGUT, SEDA; ŞENTÜRK, HAKANContext: The gastrointestinal tract is one of the most affected systems in hyperthyroidism. Although thyrotoxicosis is thought to be associated with gastrointestinal dysmotility, there are limited studies focused on motility disorders in hyperthyroidism. Objectives: We aimed to investigate the manometric measurements to determine if esophageal motility is affected in Graves' disease. Materials and methods: Thirty patients with Graves' disease (18 female and 12 male) and 30, age and sex matched, healthy controls (22 female and 8 male) were recruited to the study between 2015 and 2016. Esophageal manometry was performed using MMS (Medical Measurement Systems bv. The Netherlands) Solar GI - Air Charged Intelligent Gastrointestinal Conventional Manometry. Results: The mean lower esophageal sphincter pressure (LESP) was 16.9 ± 5.3 mmHg in hyperthyroid patients and 20.1 ± 8.8 mmHg in the control group and there was no significant difference (p>0.05). It was observed that the duration of contraction was 3.9 ± 0.7 s in healthy subjects and, significantly shorter 3.2 ± 0.5 s in hyperthyroid patients (p<0.001). Duration of contraction was negatively correlated with TSH receptor Ab titer in patients (p=0.006, r= -0.48). Also, it was observed that the duration of relaxation was negatively correlated with fT4 levels in the patient group (p<0.05, r= -0.46). Conclusion: In this study, we observed that esophageal motility can be affected via shortened duration of contraction in Graves' disease. The gastrointestinal symptoms due to possible motility dysfunctions should be considered in the evaluation of hyperthyroid patients.Publication Open Access Pancreas cyst fluid viscocity assesment in the diagnosis of mucinous cyts(2018-06-01T00:00:00Z) KÖKER, İBRAHİM HAKKI; ŞENTÜRK, HAKAN; KÖKER, İBRAHİM HAKKI; ŞENTÜRK, HAKANPublication Open Access The relationship between serum histon levels and the severity of acute pancreatitis.(2019-09-01) Biberci, Keskin; Şentürk, H; Köker, İH; Sümbül, Gültepe; İnce, AT; İNCE, ALİ TÜZÜN; SÜMBÜL, BİLGE; ŞENTÜRK, HAKANBackground/Aims: Despite various scoring systems and imaging methods, it is hard to predict the severity and the course of acute pancreatitis (AP), thereby necessitating better and more reliable markers. Since inflammation plays a key role in the pathogenesis of AP, we sought to determine whether histone, which is a novel inflammatory marker, may play a role in the prediction of severity and prognosis. Materials and Methods: A total of 88 consecutive adult patients (>18 years) with a first AP episode were prospectively enrolled in the study. Severe AP was defined as having a revised Atlanta score >3 in the first 48 h after admission. Circulating histone 3 and 4 levels were measured using the enzyme-linked immunosorbent assay method. Results: Eighty-eight consecutive adult patients with a first episode of AP were divided into two groups according to severity, in which 56 (63.6%) were assigned to the mild AP group and 32 (36.4%) to the severe AP group. White blood cell, hemoglobin, creatinine, and aspartate aminotransferase levels were significantly higher in the severe AP group. However, there was no difference in serum histone levels between the groups, and there was no correlation between revised Atlanta score and serum histone levels either. Conclusion: Serum histone levels did not significantly differ between the severe and mild AP groups. Therefore, these markers may not provide additional benefit for determining the severity of AP.Publication Open Access Comparison of tomographic and colonoscopic diagnoses in the presence of colonic wall thickening(2014-01-01) Ince, ALİ TÜZÜN; BAYSAL, Birol; KAYAR, Yusuf; Arabaci, ELİF; Bilgin, MEHMET; HAMDARD, Jamshid; YAY, Adnan; Senturk, HAKAN; İNCE, ALİ TÜZÜN; ARABACI, ELİF; BİLGİN, MEHMET; ŞENTÜRK, HAKANIntroduction and objective: Colonic wall thickening is a common condition in a number of benignant and malignant diseases. This study investigated the accuracy of radiological diagnoses in patients diagnosed with colonic wall thickening using multislice CT (MDCT). Materials and method: Files of patients with colonic wall thickening diagnosed with 64-slice MDCT were reviewed retrospectively. The colonoscopy results of these patients were grouped under neoplastic process (cancer and adenomatous polyp), inflammatory bowel disease (IBD), diverticulitis and other etiology (nonspecific events, ischemic colitis, solitary rectal ulcer, external compression, secondary to volvulus and radiotherapy), and the results were statistically evaluated. p values < 0.05 were considered statistically significant. Results: The study was performed on 505 files (290 males [57.4%], 215 females [42.6%], mean age: 49.15 ± 18.4 years). CT and colonoscopic diagnoses were reviewed and the following CT to colonoscopy ratios was observed: neoplastic process: 44.4% vs. 40.2%; IBD: 42.4% vs. 42.4%; diverticulitis: 4% vs. 4.2%; other etiology: 9.3% vs. 3.2%. Colonoscopy failed to identify pathology in 9.9% of the patients. The sensitivity, specificity, PPV, NPV and accuracy of CT were 95.6%, 90.4%, 87.1%, 96.8% and 92.4%, respectively, in detecting neoplastic processes; 97.2%, 97.9%, 97.2%, 97.9% and 97.6%, respectively, in detecting IBD; 90.5%, 99.8%, 95%, 99.6% and 99.4%, respectively, in detecting diverticulitis, and 50%, 96,7%, 62.5%, 94.6% and 92%, respectively, in detecting other etiology. Conclusion: While, accuracy of 64 slice-CT in diagnosing colonic wall thickenings secondary especially to neoplastic processes, IBD and diverticulitis was significantly higher, but differential diagnosis is challenging in pathologies due to other etiologies.Publication Open Access Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit(2018-11-01) kayar, yusuf; Baysal, Birol; Tozlu, Mukaddes; ŞENTÜRK, hakan; Atay, Musa; İNCE, ALİ TÜZÜN; ŞENTÜRK, HAKAN; İNCE, ALİ TÜZÜNBackground: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. Materials and Methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17–92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease.Publication Open Access The role of EUS and EUS-guided FNA in the management of subepithelial lesions of the esophagus: A large, single-center experience(2017-09-01T00:00:00Z) Baysal, Birol; Masri, Omar A.; Eloubeidi, Mohamad A.; ŞENTÜRK, HAKAN; ŞENTÜRK, HAKANBackground: Referral for endosonographic evaluation of subepithelial lesions seen in the gastrointestinal (GI) tract is fairly common. Although rarely studied separately in details, esophageal lesions have some unique differences from other GI sites and might deserve some special considerations regarding follow-up and management. Materials and Methods: All cases referred for endoscopic ultrasound (EUS) evaluation of subepithelial esophageal lesions at Bezmialem University Hospital, a tertiary center in Istanbul, Turkey were retrospectively reviewed. Data were collected for patient and lesion characteristics as well as for pathology results and follow-up if available. Lesions were subcategorized according to their size, location, and final diagnosis. Results: A total of 164 EUS examinations were identified. In 22.5% of cases, the lesion could not be identified by EUS. Of the remaining cases, 57.6% had a lesion larger than 1 cm in size. Extramural compression was the diagnosis in 12% and leiomyoma in around 60%. Thirteen patients had follow-up examinations with only two showing an increase in size after 12 months. Sixty-five EUS-guided fine needle aspirations (EUS-guided FNAs) were performed, with around 50% having nondiagnostic samples and 94% of the remaining samples confirming the presumptive diagnosis. Conclusions: The majority of subepithelial lesions in the esophagus are benign with extremely low malignancy potential. EUS examinations performed for lesions smaller than 2 cm as well as FNAs taken from lesions smaller than 3 cm might have minimal impact on their ultimate management and outcome. More than one FNA pass should be attempted in order to improve the yield.Publication Open Access From fatty liver to fibrosis: A tale of -second hit-(2013-02-28) Basaranoglu, METİN; Basaranoglu, GÖKÇEN; Senturk, HAKAN; BAŞARANOĞLU, METİN; BAŞARANOĞLU, GÖKÇEN; ŞENTÜRK, HAKANAlthough much is known about how fat accumulates in the liver, much remains unknown about how this causes sustained hepatocellular injury. The consequences of injury are recognized as nonalcoholic steatohepatitis (NASH) and progressive fibrosis. The accumulation of fat within the hepatocytes sensitizes the liver to injury from a variety of causes and the regenerative capacity of a fatty liver is impaired. An additional stressor is sometimes referred to as a “second hit” in a paradigm that identifies the accumulation of fat as the “first hit”. Possible candidates for the second hit include increased oxidative stress, lipid peroxidation and release of toxic products such as malondialdehyde and 4-hydroxynonenal, decreased antioxidants, adipocytokines, transforming growth factor (TGF)-β, Fas ligand, mitochondrial dysfunction, fatty acid oxidation by CYPs (CYP 2E1, 4A10 and 4A14), and peroxisomes, excess iron, small intestinal bacterial overgrowth, and the generation of gut-derived toxins such as lipopolysaccharide and ethanol. Oxidative stress is one of the most popular proposed mechanisms of hepatocellular injury. Previous studies have specifically observed increased plasma and tissue levels of oxidative stress markers and lipid peroxidation products, with reduced hepatic and plasma levels of antioxidants. There is also some indirect evidence of the benefit of antioxidants such as vitamin E, S-adenosylmethionine, betaine, phlebotomy to remove iron, and N-acetylcysteine in NASH. However, a causal relationship or a pathogenic link between NASH and oxidative stress has not been established so far. A number of sources of increased reactive oxygen species production have been established in NASH that include proinflammatory cytokines such as tumor necrosis factor (TNF)-α, iron overload, overburdened and dysfunctional mitochondria, CYPs, and peroxisomes. Briefly, the pathogenesis of NASH is multifactorial and excess intracellular fatty acids, oxidant stress, ATP depletion, and mitochondrial dysfunction are important causes of hepatocellular injury in the steatotic liver.Publication Open Access Surprise diagnosis in an adolescent case with chronic kidney damage: Answers.(2021-01-11T00:00:00Z) Doğan, Güzide; Akıncı, Nurver; Sharifov, Rasul; Şentürk, Hakan; Türk, HACI MEHMET; ÇAKIR, FATMA BETÜL; ŞENTÜRK, HAKAN; TÜRK, HACI MEHMET