Person: BAŞARANOĞLU, GÖKÇEN
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Publication Open Access Ovaries are more vulnerable than hepatocytes for insulin resistance and hyperinsulinemia(2016-01-01) GULTEPE, Ilhami; Basaranoglu, METİN; SULEYMANOGLU, Yaser; Basaranoglu, GÖKÇEN; BEYAZIT, Fatma; BAŞARANOĞLU, METİN; BAŞARANOĞLU, GÖKÇENBackground/Aims: Non-alcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS) are common metabolic disorders. We aimed to evaluate the underlying mechanisms in the development of NAFLD and PCOS.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 Inadvertent Venous Air Embolism during Cesarean Section: Collapsible Intravenous Fluid Bags Without Self-Sealing Outlet Have Risks. Case Report(2013-07-01) BAKAN, Mefkur; TOPUZ, Ufuk; Esen, ASIM; Basaranoglu, GÖKÇEN; OZTURK, Erdogan; ESEN, ASIM; BAŞARANOĞLU, GÖKÇENThe anesthesiologist must be aware of the causes, diagnosis and treatment of venous air embolism and adopt the practice patterns to prevent its occurrence. Although venous air embolism is a known complication of cesarean section, we describe an unusual inattention that causes iatrogenic near fatal venous air embolism during a cesarean section under spinal anesthesia. One of the reasons for using self-collapsible intravenous (IV) infusion bags instead of conventional glass or plastic bottles is to take precaution against air embolism. We also demonstrated the risk of air embolism for two kinds of plastic collapsible intravenous fluid bags: polyvinyl chloride (PVC) and polypropylene-based. Fluid bags without self-sealing outlets pose a risk for air embolism if the closed system is broken down, while the flexibility of the bag limits the amount of air entry. PVC-based bags, which have more flexibility, have significantly less risk of air entry when IV administration set is disconnected from the outlet. Using a pressure bag for rapid infusion can be dangerous without checking and emptying all air from the IV bag.Publication Open Access Baricity: an important issue for spinal anesthesia(2017-04-01) BAŞARANOĞLU, GÖKÇEN; BAŞARANOĞLU, GÖKÇENHip fractures occur 1.6 million times worldwide every year.1 This patient population has specific problems. General anesthesia and spinal anesthesia represent the two common approaches for these groups of patients. Compared to general, spinal anesthesia is simple and easy; it provides pain control, reduces mortality and early cognitive dysfunction.2, 3 The major disadvantages of spinal anesthesia are risks of hypotension, higher level of blockade and cardiac arrest. Intrathecal drug distribution is affected by a number of factors, including baricity, total dose, volume, concentration of the local anesthetic drug, injection site, conformation of spinal canal (presence of kyphosis, lordosis), position and cerebrospinal fluid (CSF) volume in the lumbosacral dural sac. Baricity is the ratio of density of the local anesthetic solution relative to the density of CSF at 37 °C. Isobaric solution is as the same density as the CSF. Hyperbaric solution is denser than CSF, whereas hypobaric solution is less dense than CSF. Thus, the choice of the drug baricity can be affected by patient position. Isobaric solutions have minimal effects on distribution of anesthetic and cephalad spread of spinal anesthesia. It can be an advantage for orthopedic surgery. Hypobaric local anesthetics are suitable for hip surgery in the lateraldecubitus position, because of its selectively to distribute to the non-dependent (operative) side with no extra movement of the anesthetized patient. The other advantage of hypobaric solutions is a slight head down position keeps the level of blockade from rising and, at the same time, improves venous return and hemodynamic stability.4 Levobupivacaine is one of the less cardiotoxic and neurotoxic local anesthetic drugs and it can be used for orthopedic surgery patients. Its pharmacologic properties are similar to bupivacaine but electrolyte composition is different. Levobupivacaine has a higher sodium content, osmolality and H+ ion concentration compared with bupivacaine. When the concentration of levobupivacaine is increased, sodium ion concentration is held constant, but as the concentration of bupivacaine is increa bupivacaine is increased, sodium concentration is reduced.5 In this issue of Minerva Anestesiologica, Vergari et al.6 assess a prospective randomized study comparing isobaric to hypobaric levobupivacaine for hip arthroplasty patients in lateral decubitus position. Using hypobaric levobupivacaine allows for a shorter onset time for sensory block and delayed regression of sensory and motor block in the non-dependent side without added complications. Isobaric and hypobaric bupivacaine were compared in the lateral decubitus position by Faust et al.7 Except for using levobupivacaine, results of that study were similar to those from the study by Faust et alPublication Open Access Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction(2015-04-01) Basaranoglu, METİN; Basaranoglu, GÖKÇEN; Bugianesi, Elisabetta; BAŞARANOĞLU, METİN; BAŞARANOĞLU, GÖKÇENExcessive accumulation of triglycerides (TG) in liver, in the absence of significant alcohol consumption is nonalcoholic fatty liver disease (NAFLD). NAFLD is a significant risk factor for developing cirrhosis and an independent predictor of cardiovascular disease. High fructose corn syrup (HFCS)-containing beverages were associated with metabolic abnormalities, and contributed to the development of NAFLD in human trials. Ingested carbohydrates are a major stimulus for hepatic de novo lipogenesis (DNL) and are more likely to directly contribute to NAFLD than dietary fat. Substrates used for the synthesis of newly made fatty acids by DNL are primarily glucose, fructose, and amino acids. Epidemiological studies linked HFCS consumption to the severity of fibrosis in patients with NAFLD. New animal studies provided additional evidence on the role of carbohydrate-induced DNL and the gut microbiome in NAFLD. The excessive consumption of HFCS-55 increased endoplasmic reticulum stress, activated the stress-related kinase, caused mitochondrial dysfunction, and increased apoptotic activity in the liver. A link between dietary fructose intake, increased hepatic glucose transporter type-5 (Glut5) (fructose transporter) gene expression and hepatic lipid peroxidation, MyD88, TNF-α levels, gut-derived endotoxemia, toll-like receptor-4, and NAFLD was reported. The lipogenic and proinflammatory effects of fructose appear to be due to transient ATP depletion by its rapid phosphorylation within the cell and from its ability to raise intracellular and serum uric acid levels. However, large prospective studies that evaluated the relationship between fructose and NAFLD were not performed yetPublication Metadata only Livedoid Vasculopaty and Anesthetic Management in Cesarean Delivery(2016-01-01) Basaranoglu, GÖKÇEN; IDIN, Kadir; UMUTOGLU, Tarik; Esen, ASIM; BAKAN, Mefkur; SALIHOGLU, Ziya; BAŞARANOĞLU, GÖKÇEN; ESEN, ASIMLivedoid vasculopathy (LV) is a hyalinizing vascular disease characterized by painful purple macules and papules that subsequently ulcerate. This vasculopathy may be associated with chronic venous insufficiency, deep venous thrombosis, factor V Leiden mutation, protein C deficiency, antiphospholipid syndrome, increased homocysteine levels, abnormalities in fibrinolysis, increased platelet activation and sickle cell disease. Difficult venous access, unreliable measurement of peripheral O2 saturation and increased susceptibility to venous embolic events may be a challenge for anesthetists. There is limited data about anesthetic management of livedoid vasculopathy in the literature. This case report describes successful anesthetic management of two patients with livedoid vasculopathy.Publication Metadata only Application of anesthesia under the guidance of transesophageal echocardiography in a pregnant with left atrial myxoma(2014-07-01) Basaranoglu, GÖKÇEN; UMUTOGLU, Tarik; IDIN, Kadir; SALIHOGLU, Ziya; BAŞARANOĞLU, GÖKÇENAtrial myxoma in pregnancy is rare and its clinical manifestations vary according to the size, location and mobility of the tumor. Transesophageal echocardiography which is useful to visualize cardiac anatomy and function can reveal possible wall movement abnormalities and tumor embolism. In this article, we report application of anesthesia under the guidance of transesophageal echocardiography in a pregnant patient with an intra-atrial myxoma developed within three months.Publication Open Access Fructose as a key player in the development of fatty liver disease(2013-02-01T00:00:00Z) BAŞARANOĞLU, METİN; BAŞARANOĞLU, Gökçen; SABUNCU, TEVFİK; ŞENTÜRK, HAKAN; BAŞARANOĞLU, METİN; BAŞARANOĞLU, GÖKÇEN; ŞENTÜRK, HAKANWe aimed to investigate whether increased consumption of fructose is linked to the increased prevalence of fatty liver. The prevalence of nonalcoholic steatohepatitis (NASH) is 3% and 20% in nonobese and obese subjects, respectively. Obesity is a low-grade chronic inflammatory condition and obesity-related cytokines such as interleukin-6, adiponectin, leptin, and tumor necrosis factor-a may play important roles in the development of nonalcoholic fatty liver disease (NAFLD). Additionally, the prevalence of NASH associated with both cirrhosis and hepatocellular carcinoma was reported to be high among patients with type 2 diabetes with or without obesity. Our research group previously showed that consumption of fructose is associated with adverse alterations of plasma lipid profiles and metabolic changes in mice, the American Lifestyle-Induced Obesity Syndrome model, which included consumption of a high-fructose corn syrup in amounts relevant to that consumed by some Americans. The observation reinforces the concerns about the role of fructose in the obesity epidemic. Increased availability of fructose (e. g., high-fructose corn syrup) increases not only abnormal glucose flux but also fructose metabolism in the hepatocyte. Thus, the anatomic position of the liver places it in a strategic buffering position for absorbed carbohydrates and amino acids. Fructose was previously accepted as a beneficial dietary component because it does not stimulate insulin secretion. However, since insulin signaling plays an important role in central mechanisms of NAFLD, this property of fructose may be undesirable. Fructose has a selective hepatic metabolism, and provokes a hepatic stress response involving activation of c-Jun N-terminal kinases and subsequent reduced hepatic insulin signaling. As high fat diet alone produces obesity, insulin resistance, and some degree of fatty liver with minimal inflammation and no fibrosis, the fast food diet which includes fructose and fats produces a gene expression signature of increased hepatic fibrosis, inflammation, endoplasmic reticulum stress and lipoapoptosis. Hepatic de novo lipogenesis (fatty acid and triglyceride synthesis) is increased in patients with NAFLD. Stable-isotope studies showed that increased de novo lipogenesis (DNL) in patients with NAFLD contributed to fat accumulation in the liver and the development of NAFLD. Specifically, DNL was responsible for 26% of accumulated hepatic triglycerides and 15%-23% of secreted very low-density lipoprotein triglycerides in patients with NAFLD compared to an estimated less than 5% DNL in healthy subjects and 10% DNL in obese people with hyperinsulinemia. In conclusion, understanding the underlying causes of NAFLD forms the basis for rational preventive and treatment strategies of this major form of chronic liver disease. (C) 2013 Baishideng. All rights reserved.Publication Open Access Comparison of SpO(2) values from different fingers of the hands(2015-09-29) Basaranoglu, GÖKÇEN; BAKAN, Mefkur; UMUTOGLU, Tarik; ZENGIN, Seniyye Ulgen; IDIN, Kadir; SALIHOGLU, Ziya; BAŞARANOĞLU, GÖKÇENPulse oximetry is a frequently used tool in anesthesia practice. Gives valuable information about arterial oxygen content, tissue perfusion and heart beat rate. In this study we aimed to provide the comparison of peripheral capillary hemoglobin oxygen saturation (SpO2) values among every finger of the two hands. Thirty-seven healthy volunteers from operative room stuffs between the ages of 18–30 years were enrolled in the study. They were monitored after 5 min of rest. After their non invasive blood pressure, heart rate, fasting time and body temperature were measured, SpO2 values were obtained from every finger and each of two hands fingers with the same pulse oximetry. All the SpO2 values were obtained after at least 1 min of measurement period. A total of 370 SpO2 measurements from 37 volunteers were obtained. The highest average SpO2 value was measured from right middle finger (98.2 % ± 1.2) and it was statistically significant when compared with right little finger and left middle finger. The second highest average SpO2 value was measured from right thumb and it was statistically significant only when compared with left middle finger (the finger with the lowest average SpO2 value) (p < 0.05). SpO2 measurement from the fingers of the both hands with the pulse oximetry, the right middle finger and right thumb have statistically significant higher value when compared with left middle finger in right-hand dominant volunteers. We assume that right middle finger and right thumb have the most accurate value that reflects the arterial oxygen saturation.Publication Open Access Mallory-Denk Bodies in chronic hepatitis(2011-05-07) Basaranoglu, METİN; TURHAN, Nesrin; Sonsuz, Abdullah; Basaranoglu, GÖKÇEN; BAŞARANOĞLU, METİN; BAŞARANOĞLU, GÖKÇENMallory-Denk Bodies (MDB) are important as investigators, suggesting MDB as an indicator of the histologic severity of chronic hepatitis, causes of which include hepatitis C, primary biliary cirrhosis (PBC), and nonalcoholic fatty liver disease (NAFLD). Matteoni et al scored MDB in patients with NAFLD as none, rare and many, and reported that MDB plays a prominent role in this classification scheme in an earlier classification system. In this study, we evaluated 258 patients with chronic hepatitis due to metabolic, autoimmune and viral etiologies. Liver biopsy samples were evaluated with hematoxylin and eosin, periodic acid-Schiff-diastase, Gordon and Sweet-s reticulin, Masson-s trichrome, and iron stains. Both staging and grading were performed. Additionally, MDB were evaluated and discussed for each disease. We examined patients with nonalcoholic steatohepatitis (NASH; 50 patients), alcoholic hepatitis (10 patients), PBC (50 patients), Wilson disease (WD; 20 patients), hepatitis B (50 patients), hepatitis C (50 patients) and hepatocellular carcinoma (HCC; 30 patients). Frequency of MDB was as follows; NASH: 10 patients with mild in 60% and moderate in 40% and observed in every stage of the disease and frequently seen in zone 3. PBC: 11 patients with mild in 10%, moderate in 70%, and cirrhosis in 20%, and frequently seen in zone 1. WD: 16 patients with moderate and severe in 60% and cirrhosis in 40% and frequently seen in zone 1. Hep B: 3 patients with mild in 66% and severe in 34%. Hep C: 7 patients with mild in 40% and moderate in 60% and observed in every stage. HCC: 3 patients with hep B in 2 patients. We found that there is no relationship between MDB and any form of chronic hepatitis regarding histologic severity such as alcoholic steatohepatitis and NAFLD and variable zone distribution by etiology. (C) 2011 Baishideng. All rights reserved.