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    Effect of bariatric surgery on humoral control of metabolic derangements in obese patients with type 2 diabetes mellitus: How it works
    (Baishideng Publishing Group Inc, 2015) Çetinkunar, Süleyman; Erdem, Hasan; Aktimur, Recep; Sözen, Selim
    Obesity and diabetes is a co-pandemic and a major health concern that is expanding. It has many psychosocial and economic consequences due to morbidity and mortality of this disease combination. The pathophysiology of obesity and related diabetes is complex and multifactorial. One arm of this disease process is the genetic susceptibility. Other arm is dependent on the intricate neuro-humoral factors that converge in the central nerve system. Gut hormones and the adipose tissue derived factors plays an important role in this delicate network. Bariatric surgery provides the only durable option for treatment of obesity and furthermore it provides a remission in the concomitant diseases that accompany obesity. This review provides a brief insight to all these mechanisms and tries to deduce the possible reasons of remission of type 2 diabetes after bariatric surgery.
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    Evaluation of mean platelet volume as a diagnostic biomarker in acute appendicitis
    (E-Century Publishing Corp, 2015) Erdem, Hasan; Aktimur, Recep; Çetinkunar, Süleyman; Reyhan, Enver; Gökler, Cihan; Irkorucu, Oktay; Sözen, Selim
    Background: Diagnosis of acute appendicitis remains to be challenging with up to 30% negative exploration rates. In addition to careful clinical history and physical examination, we still need easily applicable, cheap and effective biomarker. Patients and methods: A retrospective case-controlled study was designed in two groups, both containing 100 patients, acute appendicitis and control. Leukocyte count, neutrophil percentage, platelet count and meal platelet volume (MPV) were compared. Results: MPV values for acute appendicitis and control groups were 7.4 +/- 0.9 fL (5.6-10.6) and 9.1 +/- 1.6 fL (5.1-13.1). For the diagnosis of acute appendicitis, ROC analysis revealed 74% sensitivity and 75% specificity for a cut-off value of 7.95 fL of MPV, however, the diagnostic value of leukocyte count and/or neutrophil ratio was superior. Conclusion: Our results suggest that, MPV value is an important parameter in the diagnosis of acute appendicitis, but in terms of sensitivity and specificity, leukocyte count and/or neutrophil percentage is superior.
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    The effect of silymarin on hepatic regeneration after partial hepatectomy: is silymarin effective in hepatic regeneration?
    (E-Century Publishing Corp, 2015) Çetinkunar, Süleyman; Tokgöz, Serhat; Bilgin, Bülent Çağlar; Erdem, Hasan; Aktimur, Recep; Can, Serpil; Polat, Yılmaz; Sözen, Selim
    Aim: Silymarin from Silybum marianum was found to reduce liver injury. The aim of the present study was to investigate the effects of silymarin on hepatic regeneration in partially hepatectomized rats. Methods: Thirty Wistar-Albino rats were divided into 3 groups of 10 animals as sham, control and experimental groups. In the sham group (n= 10) abdominal incision was closed after laparotomy. In the control group (n= 10), the rats underwent 70% hepatectomy after laparotomy. In the experimental group (n= 10) after partial 70% hepatectomy, silymarin (200 mg/kg/d) were given to rats for 10 days. Rats in three groups were sacrificed on 10 days. Aspartate (AST) and alanine transaminase (ALT), gamma glutamyl transferase (GGT), ALP, LDH and total bilirubin levels were measured using intracardiac blood samples. Tissue malondialdehyde (MDA) and tissue glutathion (GSH) and Superoxide dismutase (SOD) levels were measured. To reveal the increase in the mass of the remnant liver tissue in the control and experimental groups relative weight of the liver was calculated. Histopathological analysis of the liver was performed using a semi-quantitative scoring system. Results: A statistically significant difference among three groups was not shown for AST and ALT levels. A statistically significant difference was found between the groups as for total bilirubin and gamma glutamyl transferase levels. Increases in relative liver weights were seen with time in Groups 2 and 3. A statistically significant difference was not found for tissue malondialdehyde, Glutathion and Superoxide dismutase levels between hepatectomy and hepatectomy + silymarin groups. On liver tissue sections of the rats in the hepatectomy + silymarin group, increased regeneration and lipid peroxidation were observed accompanied by decreased antioxidant response. Conclusion: It has been observed that silymarin with many established functions such as antiproliferative, anti-inflammatory and energy antioxidant effects, does not contributed to proliferative regeneration of the liver-which has very important metabolic functions -after partial hepatectomy; instead it will decrease serum levels of transaminases.
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    The Protective Effect of Silymarin on Cholestatic Liver Injury
    (Carbone Editore, 2015) Bilgin, Bülent Çağlar; Tokgöz, Serhat; Çetinkunar, Süleyman; Aziret, Mehmet; Erdem, Hasan; Aktimur, Recep; Sözen, Selim
    Introduction: Medical and surgical problems caused by obstructive jaundice is an important problem for surgeons and gastroenterologists. Silymarin prevents liver damage by maintaining the integrity of the plasma membrane. Purpose: The aim of this study was to evaluate whether silymarin administration would protect against cholestatic liver injury in rats with bile duct ligation. Methods: Thirty male Sprague-Dawley rats with a weight of 200-240 g were used in the study. They were randomly divided into three groups (n = 10 for each group): sham group only operated (Group I), control group was bile duct ligation (BDL) (Group II), and treatment group was IR+ BDL+silymarin (Group III) Silymarin 200 mg/kg/day was given by orally to the Silymarin group for 10 days. After 10 days, all rats were sacrificed, plasma and liver samples were obtained. Blood parameters were measured and tissue level of Glutathione (GSH), malondialdehyde (MDA) and copper/zinc superoxide dismutase (Cu / Zn SOD) were determined. The degree of portal inflammation, necrosis, vacuolar degeneration, sinusoidal dilatation, vascular congestion and fibrosis were evaluated histopathologically. Results: In the silymarin treated rats, MDA levels and liver tissue Cu-Zn SOD levels were significantly lower, while GSH levels were significantly higher than that of the BDL group (p = 0.001, p = 0.05, p = 0.001, respectively). In the BDL+silymarin group, the levels of LDH were significantly lower than that of the BDL group (p = 0.01). Conclusions: Our results supported indicate that silymarin exerts a protective and therapeutic effect on cholestatic liver injury in bile duct ligated rats.