Bircan Sonmez

Karadeniz Technical University, Atrabazandah, Trabzon, Turkey

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Publications (11)13.28 Total impact

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    ABSTRACT: Background: Acute allograft failure which occur intermittently after renal transplantation caused by graft tortion is a very rare entity. We here report highly unusual case of recurrent episodes of acute allograft dysfunction two years after kidney transplantation secondary to ischemic tubular necrosis caused by tortion of renal pedicle due to rotation of the allograft with body movements. Case Presentation: A 55 year-old male patient with living unrelated kidney transplantation for chronic renal failure caused by autosomal dominant polycystic kidney disease had presented recurrent acute deteriorations in renal functions. All laboratory values were within normal limits except elevated serum creatinine levels, acute tubular necrosis in graft biopsy, and detection of pelvic dilatation in renal ultrasonography from time to time. Changes in axis of graft in nuclear medicine scans taken at different times during the same study made us bring to mind the diagnosis of renal pedicle tortion. Renal blood flow measurements with Doppler ultrasonography in different body positions helped to reach the final diagnosis of mobile kidney right on time. The patient is now well after prompt surgical treatment with nephropexy. Discussion: Unfortunately, tortion of allograft once occurred is associated with very high rate of graft loss due to arterial compromise and infarction and it is very difficult to diagnose without high level of suspicion. We discuss the causes of renal allograft tortion and the measures to prevent its occurrence and the methods to diagnose.
    Renal Failure 02/2013; · 0.94 Impact Factor
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    ABSTRACT: The efficacy of low and high fixed dose radioactive iodine (RAI) therapy in patients with toxic nodular goiter was investigated. Ninety-three patients (25 males, 68 females) were included into the study (32 patients with toxic adenoma, 61 patients with toxic multinodular goiter). Patients were treated with a fixed dose of 370 MBq (10 mCi) or 740 MBq (20 mCi) RAI. The average follow-up period was 17±10 months. The overall cure rate (eutyhroidism and hypothyroidism) was 81% in patients treated with 740 MBq RAI and 51% in patients treated with 370 MBq RAI (p<0.05). RAI therapy with a dose of 370 MBq and 740 MBq provided the cure in 73% and 91% of the patients with toxic adenoma and 42% and 76% of the patients with toxic multinodular goiter, respectively. No significant difference for gender was observed. Hypothyroidism developed in 4 and 15 patients with a dose of 370 MBq and 740 MBq RAI, respectively. A dose of 740 MBq RAI was found to be more effective for the treatment of toxic nodular goiter as compared to a dose of 370 MBq RAI.
    Minerva endocrinologica 06/2011; 36(2):117-21. · 1.40 Impact Factor
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    ABSTRACT: Polycythemia vera (PV) is a clonal myeloproliferative disorder characterized by predominantly excessive erythrocyte production. During the course of the disease, bleeding or thrombosis may be observed. In PV patients, the influence of antifibrinolytic activities on development of thrombohemorrhagic complications remains to be elucidated. In the present study, alterations in antifibrinolytic activity of PV patients and the effects of treatments on these alterations were investigated. Newly diagnosed and therapy-naive 22 PV patients were included. Thrombomodulin (TM), plasmin-alpha 2-antiplasmin complex (PAP), plasminogen activator inhibitor-1 (PAI-1) and thrombin activable fibrinolysis inhibitor antigen (TAFIa) levels were measured in all individuals and after phlebotomy and 5-hydroxyurea (5-HU) therapy in PV patients. TM, PAP, PAI-1 and TAFIa values of the patient group were higher than those of the controls. After phlebotomy, no changes were detected in TM, PAI-1 and TAFIa values, but PAP values decreased. On the contrary, 5-HU treatment resulted in a marked decrease in TM, PAI-1, PAP and TAFIa levels. These findings suggested that the changes in antifibrinolytic activity and endothelial dysfunction might be contributed to formation of intravascular thrombosis in PV patients, even though not clinically overt. 5-HU in addition to phlebotomy affects antifibrinolytic activity and may have an influence on diminishing predisposition of thrombosis.
    Hematology (Amsterdam, Netherlands) 12/2010; 15(6):391-6. · 1.33 Impact Factor
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    ABSTRACT: Myocardial perfusion scintigraphy (MPS) is one of the widely used tools to follow developing radiation-induced heart disease (RIHD). But the clinical significance of MPS defects has not been fully understood. We have investigated the biodistribution alterations related to perfusion defects following radiotherapy (RT) and showed coexisting morphologic changes. ANIMALS, METHODS: A total of 18 Wistar rats were divided into three groups (1 control and 2 irradiated groups). A single cardiac 20 Gy radiation dose was used to induce long term cardiac defects. Biodistribution studies with technetium (99mTc) sestamibi and histological evaluations were performed 4 and 6 months after irradiation. The percent radioactivity (%ID/g) was calculated for each heart. For determination of the myocardial damage, positive apoptotic cardiomyocytes, myocardial cell degeneration, myocardial fibrosis, vascular damage and ultrastructural structures were evaluated. Six months after treatment, a significant drop of myocardial uptake was observed (p < 0.05). Irradiation-induced apoptosis rose within the first 4 months after radiation treatment and were stayed elevated until the end of the observation period (p < 0.05). Also, the irradiation has induced myocardial degeneration, perivascular and interstitial fibrosis in the heart at the end of six and four months (p < 0.01). The severity and extent of myocardial injury has became more evident at the end of six month (p < 0.05). At ultrastructural level, prominent changes have been observed in the capillary endothelial and myocardial cells. Our findings suggest that the reduced rest myocardial perfusion, occurring months after the radiation, indicates a serious myocard tissue damage which is characterized by myocardial degeneration and fibrosis.
    Nuklearmedizin 01/2010; 49(6):209-15. · 1.32 Impact Factor
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    ABSTRACT: We investigated the relationship between scintigraphic infarct size and neutrophil counts after acute myocardial infarction (AMI), which has not been adequately studied with imaging tools. Twenty-eight consecutive patients with anterior AMI were included in the study. Total white blood cell (WBC), neutrophil counts, creatine kinase-myocardial band (CKMB), and cardiac troponin (cTnT) were obtained at admission and daily during the first 72 h after a patient's arrival. Single photon emission computed tomography studies were performed at a median interval of 4 days (range, 3-5 days) after the AMI. The severity scores of perfusion defects were calculated. WBC and neutrophil counts correlated with enzymatic and single photon emission computed tomography infarct size. Leukocyte and neutrophil counts on admission and first day were positively correlated with peak CKMB, peak cTnT, and scintigraphic infarct size. There were no statistical correlations on the second and third days (P>0.05). The most significant relationship was between basal neutrophil counts and scintigraphic infarct size (r = 0.602, P<0.001). Overall, the correlation coefficients with scintigraphy were better than those with peak CKMB and cTnT levels for both WBC and neutrophil counts. Measuring basal neutrophil counts may be considered as an alternative solution in the prediction of infarct size.
    Nuclear Medicine Communications 07/2009; 30(10):797-801. · 1.38 Impact Factor
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    ABSTRACT: Multiple Myeloma (MM) is a B cell neoplasm characterized by the clonal proliferation of plasma cells. Skeletal complications are found in up to 80% of myeloma patients at presentation and are major cause of morbidity. 49 patients were enrolled with MM admitted to Black Sea Technical University Hospital between 2002-2005. Pathologic fractures (PFs) were determined and the patients with or without PF were followed up minimum 3 years for survival analysis. PF was observed in 24 patients (49%) and not observed in 25 patients (51%). The risk of death was increased in the patients with PF compared with patients who had no fractures. While overall survival was 17.6 months in the patients with PFs, it was 57.3 months in the patients with no PFs. These findings suggest that PFs may induce reduced survival and increased mortality in the MM patients, however, larger sample size is essential to draw clearer conclusions added to these data.
    Journal of Experimental & Clinical Cancer Research 04/2008; 27:11. · 3.07 Impact Factor
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    ABSTRACT: To find out the effects of hepatocyte growth factor (HGF) in the development of dendritic cells (DC) from the peripheral monocytes. The study was carried out in Black Sea Technical University Hospital, Trabzon, Turkey between 2003-2004. Seven different cytokine combinations were employed to assess phenotypical and functional differences of DCs from the peripheral monocytes in serum free culture media. Peripheral monocytes were incubated in media with cytokines for 5 days. The tumor necrosis factor-alpha (TNF-alpha) was added to the cell culture on day 5 and incubated for another 2 days. Surface and co-stimulating molecules on the cells were assessed by flowcytometry. The functional capacity of the DCs was evaluated on day 7 by purified protein derivative loading and subsequent lymphoproliferation test using methyl tetrazolium staining. On the 5th day of incubation DC development was observed in all cytokine groups, but cells were superior in cultures maintained in the presence of interleukin-4 combinations with granulocyte-macrophage colony stimulating factor (GM-CSF) or with GM-CSF+HGF. Moreover, the expression of surface and co-stimulating molecules increased significantly after incubation with TNF-alpha. The effect of PPD loaded-DCs on proliferation of lymphocytes was more striking in HGF containing groups. It was concluded that HGF supplemented cultures exert some additive effects in relation to function of monocyte-derived DCs. But HGF alone does not seem to augment monocyte-derived DC proliferation and maturation significantly.
    Saudi medical journal 06/2007; 28(5):688-95. · 0.62 Impact Factor
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    ABSTRACT: Many possible causes of resistance to human recombinant erythropoietin (rh-EPO) have been reported in patients with renal failure. This case presents an unusual cause of erythropoietin-resistant anemia in a patient with chronic renal failure. A 61-year-old male patient who was on chronic hemodialysis program due to diabetic nephropathy for seven months developed erythropoietin resistant anemia. No iron deficiency was revealed by laboratory data, no megaloblastic anemia were found by biochemical investigation, and no inflammatory states including infection or neoplastic diseases were disclosed by abdominal ultrasonography, chest X-ray, bone marrow aspiration and biopsy, or other methods (normal C-reactive protein levels). This hemodialysis patient had epoetin-resistant anemia with primary autoimmune hyperthyroidism. The anti-thyroid therapy was effective not only against the hyperthyroidism but also against his epoetin resistant anemia.
    Renal Failure 02/2007; 29(6):759-61. · 0.94 Impact Factor
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    ABSTRACT: To the Editor: The Hell J Nucl Med has printed an article comparing technetium-99m pentavalent- dimercapto succinic acid ((99m)Tc(V)-DMSA) as an effective agent diagnosing acute bone and joint infection. We now report that (99m)Tc(V) -DMSA can identify foci of infection in a case of fever of unknown origin. (99m)Tc(V)-DMSA, as a tumor-seeking agent, has been developed by Yokoyama et al. in 1981 and many other related studies have followed. We performed (99m)Tc(V) -DMSA whole body scintigraphy (WBS) in a 60 years old female patient admitted to our hospital with fever, fatigue, and right leg pain. Clinical diagnosis was cellulitis. Staphylococcus aureus was detected in blood cultures and treatment with antibiotics was initiated. After two days, the patient had joint pain, cough and dyspnea. Pneumonia and septic arthritis were diagnosed, antibiotic treatment was modified, but fever continued. A whole body scintigraphy was performed 4-5h after the intravenous administration of 740MBq of freshly prepared (99m)Tc(V)-DMSA using a dual head gamma camera (Siemens, E-Cam Dual Head, USA). The scan revealed increased tracer uptake in the right sternoclavicular region, the right lateral iliac wing, the left major trochanter and, the lower lumbar vertebrae. Magnetic resonance imaging (MRI) of the lumbar spine-pelvis and computerized/tomography (CT) of the thorax were performed and multiple abscesses were shown in the right lateral gluteal region in an area of 8x2.5cm and the right sternoclavicular joint, in an area of 2.5x2cm. In addition, appearance concordant to spondylodiscitis, an anterior epidural phlegmon at the level of L3-S1 vertebrae and a lesion concordant to bursitis in the left major trochanter were observed. All abscesses were drained but the patient was operated because there was no local improvement and neurologic symptoms appeared. Serious pyogenic infection as a cause of undiagnosed fever is common. The most widely and also currently used radionuclide agents for the detection and location of pathology in patients with undiagnosed fever are gallium 67 ((67)Ga-C) citrate, labeled leucocytes and recently fluorine-18 fluorodeoxyglucose (18F-FDG). Recently, uptake (99m)Tc(V)-DMSA by inflammatory tissues has been reported. It is suggested that (99m)Tc(V)-DMSA scintigraphy is a useful alternative to (67)Ga-C scintigraphy in the detection of intra-abdominal abscesses and inflammatory bowel disease. Compared with conventional inflammation imaging agents, i.e. (67)Ga and labeled leucocytes, (99m)Tc(V)-DMSA has superior characteristics such as it is easy to prepare, it has a lower cost and lower radiation dose, and provides results within a shorter period. Although the mechanism of accumulation has not yet been completely clarified, it is suggested that (99m)Tc(V)-DMSA infiltrates into the interstitial space of inflammatory lesions because of increased capillary permeability. It has been demonstrated that the main transport protein of (99m)Tc(V)-DMSA is albumin. Physiological uptake has been demonstrated in breast tissues, kidneys, nasal mucosa and the blood pool. Because of normal re- nal excretion, a localized lesion in the kidneys and urine bladder could not be demonstrated. If localizing infection signs are present, radiologic imaging modalities such as CT or MRI are preferred because they provide more accurate information of the local extent of soft tissues lesions. Scintigraphic techniques permit WBS and are particularly useful in identifying multifocal involvement. Thus, CT or MRI guided biopsy can then be done to elucidate the nature of the lesions. This case shows that (99m)Tc(V)-DMSA WBS is useful as a screening technique in searching inflammatory lesions.
    Hellenic journal of nuclear medicine 12(3):291-2. · 0.68 Impact Factor
  • Hellenic journal of nuclear medicine 13(1):69-70. · 0.68 Impact Factor
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    ABSTRACT: Multiple myeloma cells increase Th3 cytokine response by secreting TGF-beta, which causes defective Th1 and Th2 cytokine responses. Therefore, a significant suppression of the immune system is seen in multiple myeloma. Interferon-alpha (IFN-alpha) is used in the treatment of multiple myeloma due to its immunomodulatory and anti-tumoral effects. We attempted to define the characteristics of immune cytokine responses and the effects of IFN-alpha-2a on the immune response in multiple myeloma. Fifteen patients with multiple myeloma and 15 healthy controls were enrolled. IFN-alpha-2a, 3 million units/day x 3 times/week, was administered subcutaneously to the patients for 2 weeks. Cytokines (TGF-beta, IL-1, IL-2, IL-4, IL-10, IFN-gamma) were assessed by the ELISA method in sera of the patients in pretreatment and posttreatment periods and in the sera of the controls. IL-2 and IL-4 levels in patients, before IFN-alpha-2a, were lower than the controls, whereas TGF-beta levels were higher than the controls. In other words, Th3 cytokine response was increased and Th1 and Th2 cytokine responses were decreased in patients. A short course of IFN-alpha-2a increased IL-2 levels. These findings suggest IFN-alpha-2a may enhance nonTh3 cytokine responses in multiple myeloma patients.
    Tumori 90(4):387-9. · 0.92 Impact Factor