Search

Brucellosis is a zoonotic disease which can be transmitted from infected animals. We present a patient with hepatitis due to brucellosis who developed jaundice., Brusellozis infekte hayvanlardan insanlara bulaşan ve birçok hastalığı taklit eden, bu nedenle ayırıcı tanılarda dikkate alınması gereken bir hastalıktır. Biz klinikte ikterle kendini gösteren bir 'Brusella hepatiti' vakasını sunuyoruz.

Background Apoptosis may be defined as programmed cell death. It is involved in the normal development and homeostasis of tissues in multicellular organisms. An increased or decreased rate of apoptosis may lead to a range of diseases. Fas antigen is a cell-surface receptor that induces apoptotic pathways when treated with Fas ligand or anti-Fas antibody. There is increasing evidence that apoptosis plays an important role in the immunopathogenesis of chronic viral hepatitis, in which the Fas antigen-Fas ligand pathway is particularly involved. Methods Fas antigen expression and apoptosis (apoptotic index) were assayed using flow cytometry in the hepatocytes of 27 patients with chronic viral hepatitis. Histopathological activity, scored by Knodell's histological activity index, other histopathological parameters, serum transaminase values and patient age were then compared with apoptotic index and Fas antigen expression. Results Apoptosis and Fas antigen expression in hepatocytes were correlated closely with histological activity (grade) Of chronic viral hepatitis, but there were no correlations with histological stage, patient age or serum transaminase levels. Conclusion Apoptosis and its triggering molecule, Fas antigen, induce mechanisms that appear to be associated with the pathogenesis of chronic viral hepatitis.

Drug resistance remains a major problem in the treatment of gastric cancer. In Turkey, gastric carcinoma is the second most common cancer and, because the rate of early diagnosis is low, chemotherapy plays an important role in the treatment of the disease. We aimed to investigate expression of the multidrug resistance-1 gene (MDR-1) and its relationship with multiple prognostic factors in gastric cancers. Between 1996 and 1998, a total of 55 patients (37 men and 19 women; median age 55 years) were studied. Sections from specimens of gastric carcinomas were immunohistochemically stained to detect P-glycoprotein (which is associated with MDR-1 expression). We found MDR-1 expression in 48 (87%) of the patients. None of the multiple prognostic factors, including histological type of tumour, correlated with expression of MDR-1. Patients who had low MDR-1 expression had better survival. We conclude that the expression of MDR-1 in gastric cancer is high in Turkey, and this may be related to poor prognosis.

A study was carried out to assess whether p53 expression is related to tumour type, grade or pathological characteristics, or to prognosis, in gastric cancer. Immunohistochemical studies were performed to detect p53 protein in sections from 55 consecutive gastrectomy or partial gastrectomy specimens. Tumours were classified for T-stage, histopathological grade and pathological characteristics. Immunohistochemical staining detected p53 protein in 11 (19%) of the 55 specimens. There was no statistically significant difference between patients with p53 positively staining tumours and patients with p53 negatively staining tumours with regard to tumour grade, stage or pathological characteristics (lymph-node infiltration, depth of invasion, necrosis, or necrosis of vessels). Survival time was statistically significantly lower in patients with positively staining tumours (mean survival times 12.0 and 23.4 months, respectively). These results suggest that expression of p53 protein is related to poor prognosis in gastric carcinoma.

Background/aims: Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and peptic ulcer are considered as the major factors for upper gastrointestinal system bleeding. The objective of the study was to determine the sociodemographic and etiologic factors, management and outcome of patients with non-variceal upper gastrointestinal system bleeding in Turkey. Methods: Patients who admitted to hospitals with upper gastrointestinal system bleeding and in whom upper gastrointestinal endoscopy was performed were enrolled in this retrospective study. The detailed data of medical history, comorbid diseases, medications, admission to intensive care units, Helicobacter pylori infection, blood transfusion, upper gastrointestinal endoscopy, and treatment outcome were documented. Results: The most frequent causes of bleeding (%) were duodenal ulcer (49.4), gastric ulcer (22.8), erosion (9.6), and cancer (2.2) among 1,711 lesions in endoscopic appearances of 1,339 patients from six centers. Seven hundred and four patients were evaluated for Helicobacter pylori infection and the test was positive in 45.6% of those patients. Comorbid diseases were present in 59.2% of the patients. The percentage of patients using acetylsalicylic acid and I or other non-steroidal anti-inflammatory drug was 54.3%. Bleeding was stopped with medical therapy in 66.9%. Only 3.7% of the patients underwent emergency surgery, and a 1.1% mortality rate was determined. Conclusions: Patients with upper gastrointestinal system bleeding were significantly older, more likely to be male, and more likely to use non-steroidal anti-inflammatory drugs. Though most of the patients were using gastro-protective agents, duodenal and gastric ulcers were the contributing factors in more than 70% of the upper gastrointestinal bleeding. The extensive use of non-steroidal anti-inflammatory drug is a hazardous health issue considering the use of these drugs in half of the patients.

Background/Aims: The aim of our study was to present the epidemiological aspects of endemic upper gastrointestinal (esophageal and gastric) cancers in the Van region of Eastern Turkey. Methodology: The patients were diagnosed by esophagogastroscopy, biopsy and histopathological analysis. The control group consisted of 73 healthy subjects. Epidemiological characteristics (age, sex, dietary habits, educational status, life style) were evaluated by questionnaires. Helicobacter pylori infection was diagnosed in nontumoral gastric mucosal biopsy specimens by Giemsa staining. Results: 298 esophageal Ca and 384 gastric Ca patients were diagnosed in seven years (1994-2001). Most of the patients (90%) were of rural origin. Endoscopic prevalence rate of upper gastrointestinal (UGI) Ca was the highest (1 Ca per 7 esophagogastroscopy) in the Van region compared to other parts of Turkey. Esophageal Ca were 1.5 times more common in females whereas gastric Ca were 1.6 times more common in males. Ninety per cent of esophageal cancers were epidermoid and the remaining 10% were adenocarcinomas. Ninety-seven per cent of gastric Ca were adenocarcinomas. Helicobacter pylori infection was not significantly increased in gastric Ca patients compared to controls. Conclusions: Low educational and socioeconomic status, consumption of smoked, salted, hot, fatty foods, overdrinking hot tea and well water, cigarette smoking, poor intake of fresh fruits and vegetables and poor hygienic conditions were probable culprit factors.

Background/Aims: To gain maximal effectiveness while decreasing toxicity by giving 5-fluorouracil for 45 minutes starting just within 5 minutes after the completion of radiotherapy thrice weekly. Methodology: Thirty-eight patients with locally advanced rectal cancer were enrolled in the study. Ranges of total radiation doses were between 50.4 Gy and 61.2 Gy with a median of 59.4 Gy with fraction size of 1.8 Gy five times weekly. 5-fluorouracil was administered thrice weekly with the dose of 250300mg/m(2)/day concomitantly with radiation therapy. Results: Median follow-up time was 30 months. Administration of chemotherapy concomitant with radiotherapy (p=0.089), AJCC stage III (p=0.079), Duke's stage C (p=0.079), presence of lymph node involvement (p=0.079) and presence of local recurrence (p=0.066) appeared to be effecting distant metastasis although differences did not reach statistically significance. Mean overall survival was 46 months in patients without any distant metastasis (SD: 3.28; 95% CI: 39.46 and 52.31) while it was 35 months in patients with distant metastasis (SD: 5.71; 95% CI: 23.52 and 45.90, p = 0.0 16). Conclusions: Our results have provided further evidence of the ability of postoperative chemoradiotherapy to delay and prevent local recurrence and metastasis of rectal cancer.

Background/Aims: To determine the percentage of responders and the resectability rate for patients with locally advanced carcinoma of the rectum treated by infusional 5-fluorouracil chemotherapy and pelvic radiation. Methodology: Twenty-four patients with a diagnosis of locally advanced unresectable rectal cancer received preoperative 5-fluorouracil by intravenous infusion at the dose of 250-300mg/m(2)/day concurrent with pelvic radiation (median 50.4 Gy/28 fractions). Surgery was performed with a mean delay of 15 days after completion of irradiation and included 11 abdominoperineal resections and five anal sphincterpreserving procedures. Results: The median follow-up was 22 months. Complete histological response occurred in 6%, and tumor down-staging in 58% of cases. There was a significant difference in the rate of local control based on the distance of the tumor from the anal verge (> 5.4cm; p=0.046). Our results have suggested the importance of the total dose on the local control (p=0.061). Higher local failure rate has been observed with prolonged treatment time (p=0.018). With metastasis-free survival as the endpoint, only stage (p=0.027) was a statistically significant prognostic factor. Conclusions: The favorable influence of higher doses of preoperative radiotherapy on pathologic stage has been observed. Even after preoperative radiotherapy, postoperative staging remained a prognostic factor.

Tens asitli dekompanse sirotik hastalarda geniş volümlü parasentez sıklıkla kullanılan bir tedavi yöntemidir. Ancak parasenteze bağlı gelişebilen hipovolemi ve arteriyel vazodilatasyon; renal fonksiyonlarda bozulma, hiponatremi ve hepatorenal sendrom gibi “parasenteze bağlı dolaşım bozukluğu” adı verilen bir takım olumsuz sonuçlara yol açmaktadır. Bu çalışmada dekompanse sirotik hastalarda, terapötik parasentez esnasında Terlipressin ve Albumin’in birlikte kullanılması ile Albumin’in tek başına kullanılmasının 24 saatlik idrar volümü ve üriner sodyum atılımındaki etkinlikleri karşılaştırıldı. Tedavi sonunda hem kombinasyon grubunda hemde tekli Albumin grubunda tedavi öncesine göre 24 saatlik idrar volümünde ve sodyum atılımında istatistiksel olarak anlamlı düzeyde artış tespit edildi. [Terlipressiin + Albumin grubunda; tedavi öncesi ve sonrası idrar volümü 1103±220 mL/24 saat, 1269±474 mL/24 saat (p=0.03), tedavi öncesi ve sonrası üriner sodyum atılımı 26.0±9.1 meq/24 saat, 40.7±31.0 meq/24 saat (p=0.03). Albumin grubunda tedavi öncesi ve sonrası idrar volümü 1229±351 mL/24 saat, 1561±459 mL/24 saat (p=0.003), tedavi öncesi ve sonrası üriner sodyum atılımı 48.7±37.3 meq/24 saat, 102.3±86.1 meq/24 saat (p=0.008)]. Kombinasyon grubunda tekli Albumin grubundan farklı olarak sadece serum kreatinin düzeylerinde istatistiksel anlamlılığa ulaşan bir düşüş olduğu görüldü. Sonuç olarak seçilmiş vakalarda parasentez esnasında Terlipressin ile birlikte Albümin uygulamasının faydalı olabileceği tespit edildi. Ancak, Terlipressin’in klinik kullanımını sınırlandıran sistemik yan etkileri ve yüksek maliyetli bir tedavi olması nedeni ile bu uygulamanın rutin olarak önerilemeyeceği kanaatine varıldı. Large volume paracentesis is a commonly used treatment method in decompensated cirrhotic patients with tence ascites. However, hypovolemia and arterial vasodilatation that may be caused by paracentesis lead to some negative consequences, such as renal functional impairements, hyponatremia and hepatorenal syndrome all of which are called as “paracentesis-related circulatory dysfunction”. In this study, comparison of efficacy of Terlipressin plus Albumin versus Albumin alone on 24 hours urine volume and urinary sodium excretion during therapeutic paracentesis in decompensated cirrhotic patients with tence ascites was made. Statistically significant increases in 24 hour-urine volume and sodium excretion were found at the end of the treatment compared to the pretreatment levels in each group. [In the Terlipressin plus Albumin group, pre and pos-treatment urine volume 1103±220 mL/24 h, 1269±474 mL/24 h, respectively (p=0.03), pre and post-treatment urinary sodium excretion 26.0±9.1 mEq/24 h, 40.7±31.0 mEq/24 h, respectively (p=0.03). In the Albumin group, pre and pos-treatment urine volume 1229±351 mL/24 h, 1561±459 mL/24 h, respectively (p=0.003), pre and pos-treatment urinary sodium excretion 48.7±37.3 meq/24 h, 102.3±86.1 meq/24 h, respectively (p=0.008)]. A statistically significant decrease in serum creatinin level was observed in the combination group, but not in the Albumin group. As a result, the administration of Terlipressin plus Albumin during paracentesis was found to be able to effective in selected patients. However, it was concluded that this application can not routinely be suggested because of the fact that Terlipressin has systemic adverse effects and an expensive treatment modality, that limit its clinical use.

Difficulty in its early diagnosis, fast progression and high mortality makes esophageal carcinoma one of the most important fatal diseases in the world. Its unequal geographic distribution gives a hint to clinicians and epidemiologists an impression that this disease is definitely related to environmental factors. Deficiencies in essential vitamins and other substances in diet have been blamed for many years. Tobacco and alcohol were also found guilty for a long time. But a great majority of people in high-risk areas are Moslem and teetotalers. Therefore some other factors as nitrosamines, which were found to enhance the risk of esophageal carcinoma, should be also emphasized in the etiology of the disease. Nitrosamines are most likely acting as the promoters in the carcinogenesis of esophagus. It is difficult to explain the importance of alcohol in high-risk areas where most of the people are teetotalers.

Background/Aims: Epidemiologic studies implicate dietary factors in risk of esophageal cancer, particularly in high-incidence areas of the world. In this case-control study, 44 patients with esophageal cancer and 100 healthy controls were interviewed in the Gastroenterology Department of Teaching Hospital, School of Medicine, Ataturk University, Erzurum, Turkey. Eastern Anatolia where the study was conducted remains at a crossroads where this particular disease is endemic.. Methodology: Questionnaire included education, level of income, residence, alcohol and tobacco consumption, eating and drinking habits. The data obtained from the patients were compared to those of control cases and analyzed using multiple logistic regression, chi(2) and Student's t test. Results: The patients' economic level was lower than that of controls. There was no association between esophageal cancer and tobacco and alcohol consumption in this region. While fruit and vegetable consumption showed a significantly inverse association with esophageal cancer. Salt and polyunsaturated fat consumption as well as drinking habit of hot tea regionally known as kitlama were positively associated with esophageal cancer. Conclusions: Etiology of esophageal cancer shows slight differences in Eastern Anatolia, where esophageal cancer is more prevalent than other parts of the country, from that of other parts of the world. Drinking of hot tea 'kitlama' and low fruit diet are the most common risk factors.

Gastric carcinoma is one of the most common carcinomas and a leading cause of death from cancer in Turkey. The relationship between clinicopathological features of the disease and oncogenes is under investigation. In this retrospective study we investigated the relationships between expression of c-erbB-2 oncoprotein and grade, stage and pathological characteristics of the tumour, and prognosis. Formalin-fixed, paraffin-embedded tissue sections were prepared from gastrectomy specimens from 55 patients with gastric carcinoma. The tissue sections were stained immunohistochemically to reveal c-erbB-2 protein. Six (10%) of the tumours stained positively for c-erbB-2 protein. There was no statistically significant association ( P > 0.5) between c-erbB-2 staining and tumour grade, stage or pathological characteristics (necrosis, lymph-node infiltration), or between staining and prognosis. The results suggest that overexpression of c-erb-B-2 protein is not related to the pathological characteristics of the tumour in gastric carcinoma and is not an important prognostic indicator.

Hepatoseluler karsinoma (H CC) sıklığı; epidemiyolojik, klinik ve morfolojik özellikleri ve prognozu, dünyanın değişik bölgelerinde belirgin farklılıklar gösterir. Ülkemize ait HCC olguları hakkında halen geniş bilgi eksiklikleri mevcuttur. Bu çalışmada, son 5.5 yıl içerisinde Uludağ Üniversitesi Tıp Fakültesi Gastroenteroloji kliniğine başvuran ve histolojik olarak tamları konulan 47 HCC vakası, retrospektif olarak değerlendirildi ve böylece HCC konusunda Türkiye kanser haritasına katkıda bulunulması amaçlandı. Bizim çalışmamız, bölgemizdeki HCC vakalarında; yaş özellikleri (ortalama 60.-15) dışında, yüksek HBsAg oranı (% 56. 1), düşük anti HCV oranı(% 5.5). erkek kadın oram (4.2) açısından az gelişmiş ülkelerdeki HCC vakalar özelliklerine benzediğini göstermektedir. It has been known that there are marked differences in frequencies of HCC; epidemiologic, clinical and pathological features and prognosis of HCC in different geographic areas in the World. There is a vast lock of knowledge about HCC in Turkey. In This study, 47 cases of histological confirmed HCC admitted to the clinic of gastroenterology of Uludağ University Medical School in the last 5.5 years were evaluated retrospectively and thus it was aimed at contributing ıo map of Turkish cancerfor HCC. Our study demonstrated that HCC cas es in our region were similar to HCC cases in underdeveloped cowey in view of lıigh rate of HBsAg positivity (56.1 %), low rate of anti HCV positivity (% 5.5) ratio of men/women differences (4.2) and other features; except for age s (mean age 60.-45).

Bu çalışmada skuamöz akciğer kanserli (SQC) bir hastada ve onun birinci derece yakınlarında sitogenetik değerlendirme yapıldı. Periferik kan lenfasit kültürlerinden G-bantlama yöntemi ile yapılan sitogenetik değerlendirme sonucunda gap ve lank şeklindeki kromozom kusurlarının ve ortak frajil bölge ekspresyonunun arttığı gözlendi. Frajil bölgeler arasında en sık olarak fra(3) (p14) ekspresyonu belirlendi. In this study a patient who has squamous cell lung cancer (SQC), and his first-degree relatives have been subjected to cytogenetic evaluation. G-banding method were used on peripheral blood lymphocyte cultures. As a result of cytogenetic evaluation it has been observed that chromosomal aberrations (including gap and break) and expression of conımon fragile siles increased. The expression of fra(3) (p14) was most frequently determined between fragile sites.

ÖZET Bu çalışma Uludağ üniversitesi Tıp Fakültesi iç Hastalıkları Ana Bilim Dalı Gastroenteroloji Bilim dalına yatırılan.sirotik zeminde gelişmiş akut hepatik ensefalopatili 37 olguda yapıldı. Olgularımız rastgele iki gruba ayrılarak, birinci gruptaki hepatik ensefalopatili hastalara parenteral modifiye amino asit infüz- yon tedavisi,ikinci gruptaki vakalara ise laktu]oz+streptomisin tedavisi uygulandı.Her iki grubtaki olgulara eşit miktarda enerji sağlayacak şekilde,%30'luk dekstrozla kalori desteği sağlandı. On gün sürün çalışmada.DZAA'lerden zenginleştirilmiş modifiye amino asit solüsyonu ile tedavinin etkinliğini ve azot bilançosuna olan etkisini, laktuloz + streptomisin tedavisi ile karşılaştırdık. Ayrıcahastaların kan amonyak düzeylerini yakından takip ederek hepatik ense- falopatinin derinliği ile amonyak düzeyleri arasında korrelasyon olup olmadığını inceledik. Sonuç olarak, DZAA'lerden zenginleştirilmiş modifiye amino asit solüsyonu ile tedavi edilen olgularımızda, hepatik ensefalopati bulgularının tamamen kaybolması % 65 olarak gerçekleşirken, laktuloz ^ streptomisin tedavisi alan vakalarımızda % 58.8 olarak gerçekleşti. Bu oranlar açısından aralarında istatistiksel olarak anlamlı farklılık tespit edilmedi (p > 0.05). Her iki tedavi yöntemi ilede çalışma öncesi ve sonrası kara ciğer fonksiyonlarında anlamlı farklılık saptanmadı. Parenteral amino asit infüzyon tedavisi grubunda, günde 80 gram amino asit verilerek çalışmanın 4. gününden itibaren pozitif azot bilançosu sağlanırken, kontrol grubundaki olgular devamlı negatif azot bilançosu sergilediler. Aralarındaki fark istatistiksel olarak anlamlı bulundu (p < 0.001). Çalışma süresince PAİT grubundaki olguları % 25 'i excitus olurken, kontrol grubunda % 29.4 oranında excitus oldu. ölüm oranları açısından aralarında istatistiksel olarak anlamlı farklılık bulunmadı (p > 0.05). Hepatik ensefalopatili olgularımızın serum amonyak düzeyleri ni.korna derinliği ile karşılaştırdığımızda, aralarında istatistiksel olarak anlamlı bir korrelasyon olduğunu saptadık (p < 0.01). Çalışmamızda dallanmış zincirli amino asitlerden zenginleştirilmiş modifiye amino asit solüsyonu ile tedavi edilen hastalarda, hepatik ensefalopati bulguları en azından konvansiyonel tedavide olduğu kadar gerilemiştir. Bunun yanı sıra bu tedavi yöntemi ile hastalara yeterli kalori ve 63protein desteği sağlanabilmiştir. Bu nedenlerden dolayı hepatik ensefa- lopatinin rutin tedavisinde bu tedavi yönteminin konvansiyonel tedavi yöntemi ile kombine olarak kullanılması halinde daha başarılı sonuçlar alınacağı izlenimini edindik. Yine komalı hastalarda serum amonyak düzeyinin yakından takip edilmesinin hastalığın progresyonunu takip açısından faydalı bîr yöntem olduğu sonucuna vardık. 64 70

9 yıldır tekrarlayan, direkt hiperbilirubinemi ile karakterize sarılık atakları saptanan, 31 yaşındaki kadın hasta kliniğimize yatırılarak tetkik edildi. Dubin Johnson Sendromu tanısı konulan vakamızı bu oldukça nadir görülen bilirubin metabolizma bozukluğuna sahip olması nedeniyle takdim etmeyi uygun bulduk. 31 years old woman patient with recurrent jaundice attacks characterised by unconjugated hyperbilirubinemia for nine years is hospitalized. The case was diagnosed as Dubin Johnson Syndrome because of its relative rarity, the case is reported.

ÖZET 176 meme karsinomalı hasta tumoral dokunun cerrahi yolla çıkarılmasından sonraki devrede seri MCA değerleri ile izlendi. Bu hastalarda değişik zaman aralıkları ile toplam 833 MCA düzeyi tespit edildi. Hastalarımızı 2 gruba ayırdık; PD- hastalar izlendikleri süre boyunca hastalığın ilerlemesi ile ilgili bir bulgu göstermediler. (n=141}/ PD+ grupta ise mevcut diyagnostik metodlarla metastaz yada rekurrens bulgusu saptandı (n=35). Sınır değer olarak 11. o U/ml kabul edildi. PD- gruptaki 141 hastadan 117 si bu değerin altında MCA düzeyi gösterdi (%82}.35 PD+ hastadan 27 sinde yükselmiş MCA değeri saptandı ( %77 ). Bu gruptaki 119 MCA testi metastaz tesbitinden sonra çalışıldı ve 98 test hastalığın ilerlemesini doğru olarak gösterdi (%82). MCA testlerinin genel istatistiksel sonuçları şöyle bulundu; sensitivite %77, spesifite %82, negatif tanı için `predictive` değer %93, pozitif tanı için `predictive` değer %52. Tekrar edilen seri MCA değerleri ile PD+ grupta anlamlı bir artma izlenmiştir, PD- grupta ise tekrarlanan testlerden elde edilen grafik stabil bulunmuştur. Bu çalışmadan elde ettiğimiz sonuçlara göre MCA, mastektomi sonrası devrede meme karsinomalarının invitro monitorize edilmesinde ve metastatik vakalarda tedavinin etkinliğini izlemede önemli bir markırdır. 45

32 kronik karaciğer hastasında ve 8 kişilik kontrol grubunda humoral immünite değişiklikleri incelendi. Romatoid faktör kronik persistan hepatitli hastalarda anlamlı olarak pozitifti. IgG ve IgA nın sirotikler ve kronik aktif hepatitli hastalarda anlamlı olarak arttığı bulundu, fakat lgM sadece sirotiklerde artmıştır. IgA 'nın alkolik karaciğer hastalığında anlamlı artmamasına rağmen IgA /IgM oranı kontroller ile karşılaştırıldığında alkolik karaciğer hastalığı olanlarda bu oranın çok anlamlı arttığı bulundu. Komplimanlardan C4 'ün kronik persistan hepatitte azaldığı ve LE hücresi ve ANA pozitifliğinde istatiksel bir anlamlılık olmadığı bulundu. The changes in the humoral immunity has been investigated in 32 chronic liver disease patients and 8 controls. Rheumatoid factor was significantly positive in chronic persistent hepatitis. IgG and lgA were found to be significantly increased in cirrhosis and chronic active hepatitis patients, but lgM was increased only in cirrhotics. Though IgA levels were not elevated in alcoholic liver disease IgA/lgM ratio was significantly elevated in alcoholic liver disease patients in comparison with the control group. Also C4 has been found to be decreased in persistent hepatitis patients and there was no statistical positivity in LE cells and ANA values.

Çalışmamıza klinik muayene ile ötiroid olan 34 karaciğer hastalıkları olgu alındı. Tiroid durumunu değerlendirmek amacı ile Serum total T4 , total T3 upt., STİ, TBG, rT3, TSH düzeyleri araştırıldı. Karaciğer hastalıklı olgu grupları ile kontrol grubu arasında Serum Total T4, STİ, T3 upt., rT3 ve TSH değerleri yönünden anlamlı farklılık saptanmadı. Karaciğer hastalıklı olgu gruplarında, Serum total T3 düzeyleri kontrol grubuna göre anlamlı olarak düşük saptandı . Serum TBG düzeyleri viral hepatitli olgu grubunda en fazla olmak üzere tüm karaciğer hastalıklı olgu gruplarında kontrol grubuna göre anlamlı olarak yüksek bulundu. Karaciğer hastalıklı olgu gruplarında; düşük serum total T3 değerleri ile karaciğer fonksiyon testleri arasında ·uyum gösterilemedi. Karaciğer hastalıklı olgularda tiroid durumu saptanırken, serum total T4 , T3 düzeylerinin yanısıra total rT3 düzeylerinin de araştırılmasının uygun olacağı kanısına varıldı. Thirty-four patients', various liver diseases in euthyroid states, serum levels of total-T4 , total-T3, T 3 -upt., FTI, TBG, rT3 and TSH were investigated. Serum total-T3 levels of the patients with liver diseases were significantly lower and serum TBG levels were higher but serum rT3 levels were in the same level of the controls.

ÖZET Kolon kanser etyolojisinde diyet ve safra asitlerinin rolünü aydınlatmak amacıyla yapılan çalışmamızda 14 kolon kanserli olgu, 13 gastro intestinal sistem dışı rahatsızlığı olan olgu seçildi. Olguların diyet anemnezleri diyet uzmanlarınca hazırlanan bir anketle saptandı. 7-OH safra asit tayininde enzimatik yöntem, total safra asiti tayininde ise sülfirik asit yöntemi kullanıldı. Ayrıca, safra asit dağılımları ince tabaka kromatografisi ile kalitatif olarak incelendi. Sonuç olarak hastaların düşük et, normale yakın yağ tükettikleri anket sonucu saptandı. Dışkı total safra asitleri hastalarda düşük bulunurken, 7-OH safra asitleri dışındaki safra asitleri hastalarda hafif yüksek bulundu. Bu değerler istatistiki olarak anlamlı değildi. Bu sonuçlarla kolon kanser oluşumu ile safra asitleri arasında basit bir ilişki kuramadık. 55

Kolon kanseri etyolojisinde safra asitlerinin oynadığı rolü daha iyi anlayabilmek amacı ile yapılan araştırmada, 14 kolon kanseri olgu ve 13 gastro-intestinal sistem dışı rahatsızlığı olan olgu çalışıldı. Dışkıda total safra asitleri sülfürik asit yöntemi ile, 7-0H steroid safra asitleri ise enzimatik olarak tayin edildi. Ayrıca safra asitleri dağılımları ince tabaka kromatografisi yöntemiyle kalitatif olarak incelendi. 14 cases of colon carcinoma and 13 cases who were hospitalized because of non gastro-intestinal causes were included in this study. Total bile acids in the faeces were determined by the sulfuric acid method, 7-0H steroid bile acids were determined enzimatica. Bile acids were also examined qualitatively by thin layer chromatography.

Kronik karaciğer hastalıklarındaki immünolojik özellikler gözden geçirildi. Bu immunolojik özelliklerin tanı, tedavi ve kronik karaciğer hastalığının takibinde kullanımları tartışıldı. The immunological characteristics of chronic liver diseases have been reviewed. The use of these immunological aspects in the diagnosis, treatment and follow up of chronic liver disease is discussed.

63