Ismail Uygan’s research while affiliated with Van Yuzuncu Yil University and other places

MEN-2A is characterized by medullary thyroid carcinoma (MTC) with pheochromocytoma and sometimes parathyroid adenoma. In affected members of the family, the risk of MTC is about 100%. Biochemical screening allows tumors to be detected early but even at this stage treatment is not always curative. Missense mutations in exon 10 and 11 of the RET proto-oncogene are associated with MEN-2A. Early detection of this mutation by DNA analysis allows the identification of the carriers of the gene. We performed genetic screening in 88 members of an extended family with MEN-2A and found 18 members positive for RET mutation (Cys634Gly). Only three of these 18 RET positive cases had a previous diagnosis of medullary cancer and/or pheochromocytoma. Up to now, 12 of the RET positive cases have undergone thyroidectomy. There was extended disease with cervical lymph node metastasis in 6 of them, bilateral medullary microcancer in 3 and c-cell hyperplasia in the remaining 3. Three of the 18 RET positive patients had also pheochromocytoma. Primary hyperparathyroidism was present in only one patient. The mean age of diagnosis of medullary cancer was between 25-50 yr and mean age of death was between 35-95 yr in affected members of the family. The family had many other affected members in other cities in Turkey and in other countries throughout the world from Australia to the Netherlands. So this family is perhaps one of the most extended families with MEN-2A.

40 brucellosis is bone marrow culture which is difficult in Sri Lanka. PCR is fast, could be done in any body tissue and becomes positive after 10 days of inoculation (1). Our patient was successfully treated with the combination of oral ciprofloxacin and doxycycline for 6 weeks. Keeping in mind the possibility of brucellosis in people who are living in temporary camps, mainly in the North, East provinces in Sri Lanka, health care workers should be more alert on early diagnosis and treatment of brucellosis to prevent further spreading.

Background: In eastern Turkey, upper gastrointestinal (oesophageal and gastric) cancers are endemic and dietary factors play an essential role in carcinogenesis. Design: Laboratory analysis of benzo(a)pyrene (BP) and 1,2-benzanthracene (BA) levels in a range of cooked foods in use in the Van region. Materials and Methods: BP and BA levels (ppb) in bread and cooked meat samples were determined by high performance liquid chromatography. An analysis of variance and the multitest were used. Results: The mean BP level was highest in bread baked in a bakery using fuel oil (3.32 ppb), followed by bread baked in an oven burning dried dung, fatty pizza cooked using a wood fire and meat roasted on a liquid petroleum gas (LPG) fire (2.51, 2.37 and 2.32 ppb, respectively; p>0.05). The mean BP level in bread baked in a bakery using fuel oil was significantly higher than that in meat roasted in an oven burning dried dung, bread baked in an oven using wood fire and meat cooked using a wood fire (2.03, 1.54 and 1.39 ppb, respectively, p<0.01). Mean BA levels were highest in bread baked in an oven burning dried dung and bread baked in a bakery using fuel oil (1.06 and 1.04 ppb, respectively), followed by meat roasted using a LPG fire, fatty pizza cooked using a wood fire and meat roasted in an oven burning dried cow dung (0.91, 0.77 and 0.73 ppb, respectively, p>0.05). The mean BA levels in bread baked in an oven burning dried dung and bread baked in a bakery using fuel oil were significantly higher than those in bread baked in an oven using a wood fire and meat cooked using a wood fire (0.55 and 0.55 ppb, respectively, p<0.01). The mean BP levels were two to three times more elevated than the mean BA levels in all food samples. Conclusions: These findings reveal the carcinogenic role of traditional foods baked or cooked using animal manure or fuel oil in the Van region because of high BP and BA levels.

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. Other etiologies include carcinoma, ulcers, radiation, aortitis and foreign bodies including sewing needle, cocktail stick, open safety pin and fishbone. We report a case of a 17 year-old girl who underwent surgical treatment because of severe upper gastrointestinal bleeding which was related to an aortoduodenal fistula caused by a swallowed sewing needle. At operation, a chronic aortoduodenal fistula that contained the sewing needle was found and repaired. This is the fourth case in the literature in which a needle was found to be associated with the development of an aortoenteric fistula.

Hepatitis delta virus infection is an important cause of liver morbidity and mortality worldwide. In Eastern Turkey, hepatitis B virus infection is the major cause of chronic liver diseases. We aimed to research the role of hepatitis delta virus infection in chronic liver diseases related to hepatitis B virus infection in the Van region of Eastern Turkey. Serological markers of hepatitis B virus and hepatitis delta virus infection [HBsAg, HbeAg, Anti-HBe and Anti- hepatitis delta virus total (IgM+IgG)] were determined by ELISA test in patients with chronic hepatitis and cirrhosis. Serum hepatitis B virus DNA was determined by polymerase chain reaction (PCR) method in chronic hepatitis B patients. Hepatitis delta virus infection was detected in 5% (7/138) of asymptomatic hepatitis B virus carriers, in 16% (24/148) of chronic hepatitis B patients and in 45% (34/75) of cirrhotic hepatitis B virus patients. hepatitis delta virus infection showed a three-fold increase in chronic hepatitis (p<0.01) and nine-fold increase in cirrhosis (p<0.001) compared to hepatitis delta virus carriers. Also, it was three times more frequent in cirrhosis (p<0.001) compared to chronic hepatitis. Chronic hepatitis delta virus infection was equally distributed between sexes in patients with chronic hepatitis B virus infection, whereas chronic hepatitis B virus infection alone was three times more frequent in males (p<0.001). Mean ages of hepatitis delta virus carriers, chronic hepatitis D and hepatitis delta virus cirrhosis patients were 30.7+/-8 (14-65), 36+/-13 (19-70) and 44 +/-16 (25-55), respectively. The higher prevalence of hepatitis delta virus infection in more severe form of hepatitis B virus infection suggests that hepatitis delta virus infection increases the severity of chronic hepatitis B virus infection in the Van region. hepatitis delta virus infection remains a second major cause of chronic liver diseases in Eastern Turkey in spite of its decreasing prevalence in Western countries and in Western Turkey.

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. 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. 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. 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.

The aim of this study was to determine clinical value of alone and combined use of serum cytokeratin (CK)-18, carcinoembryonic antigen (CEA) and CA 19-9 in esophageal squamous cell carcinoma and gastric adenocarcinoma. Serum tumor markers were measured in 60 patients who had esophageal squamous cell carcinoma or gastric adenocarcinoma. Thirty healthy subjects served as controls. In patients with gastric adecarcinoma serum CK-18 levels were significantly increased compared to both esophageal squamus cell carcinoma and control groups (p<0.01, p<0,05 respectively). But there was no significant difference in CK-18 levels between esophageal squamous cell carcinoma patients and healthy subjects (p>0.05). On the other hand, serum CEA and CA 19-9 levels did not differ between groups (p>0.05). The sensitivity of serum CK-18, CEA and CA19- 9 in esophageal squamous cell carcinoma were 53%, 70% and 66%, respectively. For gastric adenocarcinoma, the sensitivity of each tumor marker was similar 70%, 70% and 70%, respectively. CK-18/CA19-9 combination in the esophageal (83%) and gastric carcinomas (93%) were found to be more sensitive than other tumor markers when these markers were evaluated in combination. CEA exhibited the highest sensitivity for esophageal squamous cell carcinoma compared to CK-18, and CA19-9. However, the sensitivity of all tumor markers in gastric adenocarcinoma were similar. The combination of CK-18 and CA19-9 could increase the diagnostic sensitivity in esophageal and gastric carcinomas.

Hepatoprotective activity of Foeniculum vulgare (fennel) essential oil was studied using a carbon tetrachloride-induced liver fibrosis model in rats. The hepatotoxicity produced by chronic carbon tetrachloride administration was found to be inhibited by Foeniculum vulgare essential oil with evidence of decreased levels of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and bilirubin. Histopathological findings also suggest that Foeniculum vulgare essential oil prevents the development of chronic liver damage. The changes in body weights in the rats assigned to the study groups supported these biochemical and histopathological findings. The results of this study clearly indicate that Foeniculum vulgare essential oil has a potent hepatoprotective action against carbon tetrachloride-induced liver fibrosis in rats.

Hepatoprotective activity of Foeniculum vulgare (fennel) essential oil was studied using a carbon tetrachlo-ride-induced liver fibrosis model in rats. The hepatotoxicity produced by chronic carbon tetrachloride admin-istration was found to be inhibited by Foeniculum vulgare essential oil with evidence of decreased levels of serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and bilirubin. Histopatho-logical findings also suggest that Foeniculum vulgare essential oil prevents the development of chronic liver damage. The changes in body weights in the rats assigned to the study groups supported these biochemical and histopathological findings. The results of this study clearly indicate that Foeniculum vulgare essential oil has a potent hepatoprotective action against carbon tetrachloride-induced liver fibrosis in rats.