Hepatitis: Tahan V

Ozaras R, Tahan V. · Istanbul University, Cerrahpasa Medical School, Infectious Diseases Department, TR-34098 Cerrahpasa, Istanbul, Turkey. · Expert Rev Anti Infect Ther. · Pubmed #19344247 No free full text.

Abstract: HCV can cause acute or chronic hepatitis and is a health problem all over the world. It is one of the leading causes of cirrhosis and hepatocellular carcinoma, and is a common indication for liver transplantation. Unrecognized patients with HCV infection may transmit the virus to uninfected people. The acute form of the disease leads to chronic hepatitis in the majority of cases. Since the success rate of treatment given in the chronic phase is much lower than that given in the acute phase, recognizing acute hepatitis is critical. Although HCV is less prevalent since 1990s in the Western world after improved blood-donor screening programs, needle-exchange facilities and education among intravenous drug users, it is still endemic in some regions, including African countries, Egypt, Taiwan, China and Japan. Acute HCV infection may be a challenge for the clinician; since it is often asymptomatic, detection and diagnosis are usually difficult. After an incubation period of 7 weeks (2-12 weeks), only a minority of patients (10-15%) report symptoms. The spontaneous clearance of the virus is more frequent primarily during the first 3 months of clinical onset of the disease, but may occur anytime during the 6 months of acute infection. This spontaneous resolution seems to be more frequent in symptomatic cases. Viremia persisting more than 6 months is accepted as chronic infection. The virus is transmitted more frequently through infected blood or body fluids. Detection of antibodies against HCV is not a reliable method of diagnosing acute HCV infection since the appearance of antibodies against HCV can be delayed in up to 30% of patients at the onset of symptoms. Thus, the diagnosis of acute hepatitis C relies on the qualitative detection of HCV RNA, which may appear as early as 1-2 weeks after exposure quickly followed by highly elevated alanine aminotransferase. After a follow-up period of 8-12 weeks for allowing spontaneous resolution, treatment should be initiated. Pegylated interferon monotherapy for 24 weeks seems effective, and the therapy can be individualized according to the characteristics of the patient.

Tahan V, Ozdogan O, Tozun N. · Marmara University, School of Medicine, Department of Gastroenterology, Istanbul, Turkey. · Rocz Akad Med Bialymst. · Pubmed #14737935 No free full text.

Abstract: The prevalence of viral hepatitis is high and remains a serious public health challenge throughout the world. New molecular biology techniques provided a better understanding of the viruses over the last decades. Novel therapeutic options seem to be promising but preventing measures including donor screening, immunization against hepatitis A virus (HAV) and hepatitis B virus (HBV), universal use of disposable syringes and implementation of better hygienic conditions play a major role in the control of viral hepatitis. The Mediterranean basin has special demographic and socioeconomic features. We reviewed in this article the seroepidemiological features of viral hepatitis in this particular region. Improving general conditions led to a tendency to be infected in older ages with HAV. Hepatitis B and C virus still remain to be the major causes of chronic hepatitis. The seroprevalence of hepatitis D virus, which was once endemic in the Mediterranean region seem to decrease nowadays whereas hepatitis E virus is still prevalent in some areas. Other viruses such as hepatitis G virus (HGV), TT virus (TTV) and SEN virus do not seem to be a major problem and their clinical importance remains to be determined in further studies.

Tahan V, Ozseker F, Guneylioglu D, Baran A, Ozaras R, Mert A, Ucisik AC, Cagatay T, Yilmazbayhan D, Senturk H. · Gastroenterology Institute, Marmara University, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #12645805 No free full text.

Abstract: Although interferon has not been classified in the pathogenesis of sarcoidosis, it may rarely lead to this disease during treatment of chronic hepatitis C. The case of a 36-year-old woman with chronic hepatitis C who developed sarcoidosis within 10 weeks of treatment with recombinant interferon-alpha2a and ribavirin is described and all seven similar cases published in English from 1989 to 2001 are discussed.

Mert A, Tabak F, Ozaras R, Tahan V, Senturk H, Ozbay G. · No affiliation provided · J Clin Gastroenterol. · Pubmed #11588555 No free full text.

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Tabak F, Gunduz F, Tahan V, Tabak O, Ozaras R. · Department of Infectious Diseases and Clinical Microbiology, Istanbul University, Cerrahpasa Medical Faculty, 34303, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #18958618 No free full text.

Abstract: Sertraline is a commonly prescribed selective serotonin reuptake inhibitor drug. Hepatotoxicity caused by sertraline is rare. Asymptomatic elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels have been rarely reported and shortly normalize after discontinuation of the agent. We present a case of severe drug-induced hepatitis in a patient receiving sertraline. To our knowledge, this is the seventh case in the medical literature as being associated with severe hepatotoxicity. Since it is extremely rare, we do not suggest a strict laboratory monitoring. However, sertraline should be discontinued in cases with symptoms implying hepatotoxicity and the patients should be informed of the potential of this side effect.

Tahan V, Canbakan B, Balci H, Dane F, Akin H, Can G, Hatemi I, Olgac V, Sonsuz A, Ozbay G, Yurdakul I, Senturk H. · Department of Gastroenterology, Pasabahce State Hospital, 34800 Istanbul, Turkey. · Hepatogastroenterology. · Pubmed #18795706 No free full text.

Abstract: BACKGROUND/AIMS: Hepatocyte apoptosis is an important and invasive predictor of liver injury and fibrosis in non-alcoholic fatty liver disease (NAFLD). Increased gamma-glutamyltranspeptidase (GGT) level is frequently observed in NAFLD. Hepatocyte growth factor (HGF) stimulates fibrogenesis and is correlated with GGT. The study aimed to determine whether GGT can distinguish NAFLD patients at high risk. METHODOLOGY: Fifty biopsy-proven NAFLD patients (M/F: 24/26) were divided as the normal GGT group (n = 25) and the high GGT group (n = 25) (each patients' GGT > two fold of upper-limit of normal). Liver histology was graded according to Brunt et al. TNF-sRp55, caspase-3 and 8, NFkappaB and Bcl-2 were measured by immunohistochemical methods. For statistical analysis, Student's t test, chi-square test, multivariate regression analysis and the area under receiver operating characteristic (ROC) curve were used. RESULTS: The high GGT group had significantly higher NFkappaB, caspase-3 and 8, and Bcl-2 levels (54.52 +/- 26.02, p = 0.002; 55.95 +/- 27.18, p = 0.002; 47.85 +/- 28.04, p = 0.001; 11.19 +/- 12.33, p = 0.016, respectively). Serum TNF-sRp55 levels of both groups were similar (2922.93 +/- 307.26, and 2885 +/- 194.47; p = 0.78). Differences in reference to histological steatosis grade and inflammation were not significant. However, fibrosis stage was higher in the high GGT group (p = 0.048). CONCLUSION: Multinominal logistic regression analysis showed that increased GGT level was a risk factor for advanced fibrosis in NAFLD (OR: 1.0, CI: 0.98-1.01; p =0.032). Using serum GGT levels the area under the ROC curve for the prediction of advanced fibrosis was 0.74 (95% CI: 0.54-0.94). The serum GGT cut-off value for the prediction of advanced fibrosis was 96.5 U/L; with 83% sensitivity and 69% specificity.

Tabak F, Ozdemir F, Tabak O, Erer B, Tahan V, Ozaras R. · Istanbul University, Cerrahpasa Medical Faculty, Department of Infectious Diseases. · Ann Hepatol. · Pubmed #18626439 No free full text.

Abstract: Hepatitis A virus (HAV) is the most common cause of acute viral hepatitis in the world. Rarely, acute infection may persist for a long time. Autoimmune hepatitis (AIH) may provide anti-HAV IgM positivity detection for a prolonged time. On the other hand, HAV as an infectious agent may also trigger AIH. Here we presented a case which seemed like a simple acute viral hepatitis A infection at the beginning but turned out to be an AIH according to the International Autoimmune Hepatitis Group's system. A 21-year-old female was diagnosed as symptomatic acute HAV infection with anti-HAV IgM positivity and elevated aminotransferase levels. The other viral serological tests were negative. On the 6th, 12th and 18th months of the follow up, her anti-HAV IgM positivity still continued and transaminase levels were also 3 to 7 times high of the upper limit of normal. In addition, antinuclear antibody was positive. However, on the 19th month anti-HAV IgM could be detected as negative. Liver histology was prominent. The patient had a score of 16 according to the International Autoimmune Hepatitis Group's system. She was given prednisolone (10 mg/day) and azathioprine (100 mg/day). The aminotransferase levels were detected within normal ranges at the end of the first month of therapy. She was in remission during follow up for 6 years. In conclusion, prolonged HAV infection and AIH may not only trigger each other but also deteriorate the liver histology. AIH should be investigated in cases of long-lasting HAV infection in order to begin the treatment earlier. On the other hand, AIH patients should also be vaccinated for both HBV and HAV to avoid more severe diseases.

Senturk H, Tahan V, Canbakan B, Uraz S, Ulger Y, Ozaras R, Tabak F, Mert A, Ozbay G. · Department Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · Neth J Med. · Pubmed #18490796 links to  free full text

Abstract: BACKGROUND: The effect of conventional interferon-based therapy of hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infection is controversial. Yet, no studies have been carried out into pegylated interferon treatment for chronic HBV/HCV coinfection. We aimed to evaluate the response rate and side effects of conventional or pegylated interferon combined with ribavirin on chronic HBV/HCV coinfection therapy. METHODS: The study included 36 chronic hepatitis patients (M/F: 28/8, mean age 47+/-12 years) who were positive for HBsAg and anti-HCV. They were tested for the presence of HBV-DNA by hybridisation assay, and the samples giving negative results were retested by polymerase chain reaction (PCR). All patients were tested for HCV-RNA using PCR, and the HCV genotype was determined. RESULTS: Nineteen patients were given standard interferon either alone or in combination with ribavirin, whereas 17 were given pegylated interferon and ribavirin combination therapy. None of the patients had HBV-DNA positivity; however, all had HCV-RNA detectable by PCR. All the patients had HCV genotype 1b. The mean alanine aminotransferase and aspartate aminotransferase levels were 118+/-65 U/l and 90+/-95 U/l respectively. Five patients in each group discontinued the treatment due to side effects. Only two patients (one from each group) reached sustained virological response. CONCLUSION: Neither pegylated nor conventional interferon based regimes were effective for HBV/HCV coinfection, in which the dominant virus was HCV. Pegylated interferon and ribavirin therapy was not superior to conventional interferon based regimes in the treatment of HBV/HCV coinfection.

Ozaras R, Tabak F, Tahan V, Ozturk R, Akin H, Mert A, Senturk H. · Department of Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul University, 34098, Cerrahpasa, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #18409002 No free full text.

Abstract: BACKGROUND AND AIM: Viral load is used for the diagnosis and monitoring the treatment of chronic hepatitis B (CHB). These methods are molecular-based and are expensive. Previous studies suggest that quantitative hepatitis B surface antigen (HBsAg) studied by automated chemiluminescent microparticle immunoassay can be a surrogate marker. In this study, we aimed to investigate whether quantitative HBsAg correlates hepatitis B virus (HBV) DNA levels during CHB treatment. METHODS: The study included 18 patients (13 male, 5 female, mean age: 33 +/- 9 years) with CHB. They were given pegylated interferon +/- lamivudine for 52 months and serum samples were obtained in weeks 0, 4, 8, 24, 48, 52, and 76. HBV DNA was measured by TaqMan polymerase chain reaction (PCR; Erasmus MC, University Medical Center, Rotterdam, The Netherlands). Quantitative HBsAg was studied by automated chemiluminescent microparticle immunoassay (Architect HBsAg, Abbott, IL). Results HBV DNA levels were measured as follows: 9.66, 7.69, 7.06, 5.93, 5.89, 5.88, and 7.27 logarithmic genome equivalent/ml, respectively. The corresponding HBsAg quantitation results were 42,888, 31,176, 37,882, 27,277, 28,279, 29,471, and 31,535 IU/ml, respectively. They showed a significant correlation (canonical correlation = 0.85). CONCLUSIONS: HBsAg studied by automated chemiluminescent microparticle immunoassay correlates with HBV DNA and can be a surrogate marker during the monitoring of the efficacy of HBV treatment.

Senturk H, Tahan V, Canbakan B, Dane F, Ulger Y, Ozaras R, Tabak F, Ozbay G. · Istanbul University Cerrahpasa Medical Faculty Department of Gastroenterology, Istanbul. · Ann Hepatol. · Pubmed #18376366 No free full text.

Abstract: There is controversial data in the literature about the characteristics or features of dual hepatitis B and C infection. Several studies have reported that the dual infection has a more severe histological picture; faster progression leading to cirrhosis and a higher risk for hepatocellular carcinoma compared with the single infections. These findings have not yet been supported. We assessed the patients with dual hepatitis B and C infection with respect to their different features in our country. METHOD: the chronic hepatitis patients of our clinics were tested, and both HBsAg and anti-HCV positive patients with chronic hepatitis were enrolled to the study. All patients were tested for the biochemical parameters and the presence of HBV-DNA and HCV-RNA. RESULTS: Of the 1950 patients, 51 (2.6%) were both HBsAg and anti-HCV positive and 67 were anti-delta positive. Patients were followed up for 5.4+/-2.1 years. Of the 51 dual hepatitis patients, 6 had no HBV-DNA and HCV-RNA detectable by PCR, 36 were only HCV-RNA positive, 9 were only HBV-DNA positive and 3 were both HBV-DNA and HCV-RNA positive. Dominant infection in (3/4) of the patients was hepatitis C. Clinical and histological properties of the cases with dual Hepatitis B and C infection showed no significant differences compared to the single infections. In conclusion, regarding the prognosis, no significant differences were found between such dual and single infections. Dual infection with hepatitis B virus and delta virus is a significantly more severe condition than the dual infection with hepatitis B and C viruses.

Canbakan B, Senturk H, Tahan V, Hatemi I, Balci H, Toptas T, Sonsuz A, Velet M, Aydin S, Dirican A, Ozgulle S, Ozbay G. · Department of Gastroenterology, Cerrahpasa Medical Faculty of Istanbul University. · Acta Gastroenterol Belg. · Pubmed #18074737 No free full text.

Abstract: The correlation between biochemistry, imaging-studies and histology is a matter of controversy in non-alcoholic fatty liver disease (NAFLD) and the major pathophysiology of non-alcoholic steatohepatitis (NASH) is still unknown. We aimed to perform a comparative analysis between clinical, biochemical and histological variables of NAFLD. One-hundred and five NAFLD patients (F/M: 51/54), were studied, all with no-alcohol intake. The groups were followed-up for six months. Necroinflammation and fibrosis were more severe in patients with diabetes (p = 0.002, and p = 0.0001, respectively). In comparing NAFL to NASH, plasma nitric-oxide and malondialdehyde levels were significantly higher (p = 0.05, for-both), and vitamin-E and-C levels were significantly lower in NASH (p = 0.002, and 0.001, respectively). The serum ferritin levels were higher in NASH patients (p = 0.016). While the ultrasonographic grade was significantly higher, the liver-spleen density gradient was significantly lower in NASH group (p = 0.017, and 0.005, respectively). Within a six month period, serum ALT levels dropped into the normal range in 23/76 (30.3%) patients and serum ALT in the 6th month correlated significantly with the severity of steatosis, inflammation and fibrosis in initial biopsy (p = 0.023, 0.035, 0.011, respectively). In conclusion, the probability of severe liver disease is higher in patients with elevated-ALT in NAFLD. Serum ferritin levels have some prognostic significance in liver damage and fibrosis. Overt diabetes is predictive of advanced fibrosis and inflammation. However impaired glucose-tolerance is not. The advice on diet and exercise for six months after diagnosis may be a good strategy in NAFLD. The patients with normal-ALT without hepatomegaly, morbid-obesity and diabetes seem to have a good prognosis, however some of these patients may still require liver biopsy.

Canbakan B, Senturk H, Tabak F, Akdogan M, Tahan V, Mert A, Sut N, Ozaras R, Midilli K, Ozbay G. · Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · J Gastroenterol Hepatol. · Pubmed #16677149 No free full text.

Abstract: BACKGROUND AND AIM: Delta hepatitis is characterized by rapidly progressive liver disease with adverse prognosis in most patients. Patients benefit from high doses and prolonged courses of interferon (IFN) therapy; however, lamivudine as a single agent has been disappointing. Data relating to the efficacy of IFN and lamivudine in combination is limited. The aim of this study was to test the efficacy of IFN-alpha 2b and lamivudine combination treatment in comparison to IFN-alpha 2b alone in patients with chronic delta hepatitis. METHODS: Twenty-six patients with chronic delta hepatitis were randomized into two groups. Twelve patients received IFN-alpha 2b alone (eight men, four women; mean +/- SD age: 43.83 +/- 8.57 years), and 14 patients received IFN-alpha 2b plus lamivudine combination (seven men, seven women; mean +/- SD age: 42.5 +/- 11.02 years). The dose of IFN-alpha 2b was 10 MU t.i.w. and of lamivudine was 100 mg/day. The groups were comparable in reference to serum alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin, albumin levels, histological activity and stage. Four patients (33.3%) in the IFN group and two (14.3%) in the combination group had cirrhosis (P = 0.2). The duration of treatment was 48 weeks with an untreated follow-up period of at least 96 weeks (mean +/- SD, 3.1 +/- 1.9 years). A liver biopsy was performed at the end of treatment. RESULTS: Eight patients from the IFN group and 11 from the combination group completed treatment. Serum ALT values became normal in 8/14 patients (57.1%) treated with IFN plus lamivudine and in 5/12 patients (41.7%) treated with IFN alone (P = 0.43). Serum hepatitis delta virus RNA was no longer detectable in nine of 14 (64.3%) patients treated with IFN plus lamivudine as compared to five of 12 (41.6%) patients treated with IFN alone (P = 0.024). In both groups female patients had significantly better virological response rate (P = 0.007). There was a significant improvement in histological activity in the combination group (mean decrease 5.27 +/- 1.08 score, P = 0.001), but not in the IFN group (mean decrease 1.44 +/- 1.59 score, P = 0.39). No significant improvement was observed in regards to fibrosis. Four of the 14 patients (28.6%) treated with combination therapy as compared to two of 12 patients treated with IFN (16.7%) were sustained virological responders (P = 0.47). The 5-year survival rate was 65% in the IFN group and 85% in the combination group (P > 0.05). CONCLUSION: Interferon and lamivudine in combination is an encouraging treatment method and may be superior to IFN alone in chronic delta hepatitis.

Yildirim B, Tahan V, Ozaras R, Aytekin H, Mert A, Tabak F, Senturk H. · Department of Gastroenterology, Marmara University School of Medicine, Istanbul, Turkey. · Dig Dis Sci. · Pubmed #16416188 No free full text.

Abstract: Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the worldwide. This infection is often insidious and one-half of infected patients are asymptomatic. Determination of risk factors for HCV transmission is very important. The aim of this study was to assess the risk factors, transmission to spouses and children for HCV infection in Turkish population. One hundred and fifty-one patients with chronic hepatitis C and 151 control cases were investigated for the probable risk factors of HCV infection. Complete blood count, ALT, AST, albumin, prothrombin time, upper abdomen ultrasonography assessment and percutaneous liver biopsy (not for cirrhotics) were performed in all patients with chronic hepatitis C. Anti-HCV testing was done by using second-generation ELISA in 302 cases. Minor surgical operation (p < 0.001), major surgical operation (p = 0.001), blood transfusion (p < 0.001), multi-partner sex (p < 0.05), frequent dental therapy (p < 0.05), and dental extraction (p < 0.001) in patients with a chronic HCV infection were found to be higher than the control group. No significant difference was found in other risk factors. The rate of hepatitis C virus in index cases was found to be 1.8% in their spouses and 1.2% in their children. Our study showed that surgical operation, frequent dental therapy, dental extraction, multi-partner sex, and blood transmission are the main risk factors for HCV infection in Turkish community.

Tahan V, Karaca C, Yildirim B, Bozbas A, Ozaras R, Demir K, Avsar E, Mert A, Besisik F, Kaymakoglu S, Senturk H, Cakaloglu Y, Kalayci C, Okten A, Tozun N. · Marmara University School of Medicine, Department of Gastroenterology Altunizade, Istanbul, Turkey. · Am J Gastroenterol. · Pubmed #15784025 No free full text.

Abstract: BACKGROUND AND AIMS: The sexual transmission of hepatitis C virus (HCV) is debated. By excluding other risk factors, the role of sexual intercourse in the transmission could be detected more accurately. We screened HCV prevalence and risk factors in the spouses of chronic hepatitis C (CHC) patients and followed the seroconversion rate of anti-HCV negative spouses. PATIENTS AND METHODS: Six hundred spouses of CHC patients were recruited. The spouses' HCV risk factors were questioned and the spouses were tested for anti-HCV. The 216 spouses who were anti-HCV negative were checked annually for anti-HCV. RESULTS: Anti-HCV was positive in 12 of 600 (2%) of the spouses. Of the 12 anti-HCV positive spouses, 11 were HCV-RNA positive. Of anti-HCV positive and negative spouse groups, mean age was 52.3 +/- 9.8 and 49.8 +/- 12.4 yr; duration of marriage was 1521 +/- 506.7 and 1532.4 +/- 670.2 wk (p > 0.05); and the number of total sexual intercourse was 434 +/- 295 and 307 +/- 333 (p= 0.055), respectively. In our prospective study, none of the spouses developed anti-HCV seroconversion in mean 35.7 +/- 6.3 months and 257.9 +/- 72.2 sexual intercourse. CONCLUSIONS: Anti-HCV was found positive in 2% of the spouses. None of the seronegative spouses developed seroconversion in the 3-yr follow-up period. This is the first study that stresses the importance of the total number of sexual intercourse in sexual transmission (p= 0.055). Our results of special monogamous group with very limited risk factors support the role of number of total sexual intercourse in HCV transmission. However, the seroprevalence rate of the spouses was still within the upper limit of our country population.

Tahan V, Ozaras R, Lacevic N, Ozden E, Yemisen M, Ozdogan O, Mert A, Tabak F, Avsar E, Celikel CA, Ozbay G, Kalayci C, Senturk H, Tozun N. · Department of Gastroenterology, Marmara University, Medical Faculty. · Dig Dis Sci. · Pubmed #15573907 No free full text.

Abstract: An increasing frequency of hepatic granulomas, up to 10%, in chronic hepatitis C patients is reported, and their presence is considered to be a predictor of treatment success. However, there is only one prevalence study on granuloma in chronic hepatitis B, and its significance for treatment outcome is unknown. We aimed to determine the prevalence of hepatic granulomas in a larger group of chronic hepatitis B patients and to compare their presence with the response to interferon therapy. Biopsy specimens of chronic hepatitis B patients were reevaluated for the presence of hepatic granulomas. All patients with hepatic granuloma were screened for other granulomatous diseases by tuberculin skin test, chest X-ray and computed tomography, venereal disease research laboratory, Brucella agglutination tests, and exposure to hepatotoxic agents. We screened 663 cases of chronic hepatitis B. Hepatic granulomas were found in 10 cases (1.5%). The granulomas could not be ascribed to any other reason. Of the 10 patients with hepatic granulomas, 4 responded to interferon therapy, 2 dropped out, and 4 were nonresponders. We conclude that hepatic granuloma is a rare finding in chronic hepatitis B and its presence does not seem to predict the response to interferon therapy.

Ozaras R, Tahan V, Mert A, Uraz S, Kanat M, Tabak F, Avsar E, Ozbay G, Celikel CA, Tozun N, Senturk H. · Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. · J Clin Gastroenterol. · Pubmed #15100526 No free full text.

Abstract: OBJECTIVES: Hepatic granulomas are not usual findings in chronic hepatitis C. A few studies addressing the frequency of hepatic granulomas in chronic hepatitis C reported it as less than 10%. The presence of it has been suggested to predict a favorable response to interferon treatment. Also, case reports described the development of hepatic granulomas after interferon treatment. In this study, we aimed to detect the prevalence of hepatic granulomas in chronic hepatitis C and to identify the causes other than chronic hepatitis C, if present, to search whether there is an association between the presence of granuloma and response to interferon treatment and also to see whether interferon leads to the formation of hepatic granulomas. METHODS: Patients from 3 university clinics were included. All patients with chronic hepatitis C were determined. All patients with hepatic granulomas were screened for the other causes of hepatic granuloma with tuberculin skin test, chest X-ray and computed tomography, Venereal Disease Research Laboratory, and Brucella agglutination tests. The histologic assessment of liver biopsies was done by the same pathologist in each center. RESULTS: A total of 725 liver biopsies of 605 patients with chronic hepatitis C were screened. In 8 patients, hepatic granulomas were detected in the initial liver biopsies. Four patients had repeat biopsies, and all had hepatic granulomas again. The prevalence of hepatic granulomas in patients with chronic hepatitis C was calculated as 1.3% (8 of 605) in reference to patient population. Presence or absence of hepatic granulomas was seemingly stable. All patients with hepatic granulomas had negative results of tuberculin skin test, Venereal Disease Research Laboratory, chest X-ray and computed tomography, and Brucella agglutination tests. All repeat biopsies were obtained after interferon (+/- ribavirin) in varying doses and duration. Four of 8 patients with hepatic granulomas were found to respond interferon therapy. No patient was found to develop hepatic granulomas after interferon therapy. CONCLUSION: Hepatic granulomas are a rare finding in HCV infection. The presence of it does not seem to predict the response to interferon therapy. The development of hepatic granulomas during interferon therapy is not usual.

Altiparmak MR, Ataman R, Ozaras R, Tahan V, Aydin S, Uzun H, Serdengecti K, Soysal T. · Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey. · Ren Fail. · Pubmed #11921696 No free full text.

Abstract: BACKGROUND AND AIM: Although the majority of patients with end stage renal failure have anemia, some have relative erythrocytosis. Patients treated with continuous ambulatory peritoneal dialysis (CAPD) having relative erythrocytosis were studied in order to determine the factors that would be responsible. METHODS: Nine out of 89 CAPD patients (10%) were identified as having relative erythrocytosis. Age-, sex- and duration of disease-matched eight patients undergoing CAPD were taken as control. Beside factors of etiologies of renal failure, smoking, renal cysts, viral hepatitides, residual renal function, the adequacy of CAPD, nutritional status, hypertension, serum levels of erythropoietin, IL-1, IL-6, TNF-, and IGF-1 levels were also investigated. RESULTS: Relative erythrocytosis occurred most often in diabetic and amyloidosis patients. None of the parameters studied were found to be significantly different between groups. During 2-year follow-up, although statistically non-significant, patients having relative erythrocytosis seemed to have higher mortality rate due to vascular complications. CONCLUSION: No single factor seemed to explain erythrocytosis in patients undergoing CAPD. Being diabetic or with amyloidosis may increase the risk.

Ozaras R, Ipekci S, Kumbasar H, Aybar Y, Tahan V, Mert A, Ozturk R, Tabak F. · No affiliation provided · J Clin Gastroenterol. · Pubmed #18607296 No free full text.

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Ozaras R, Yilmaz M, Mete B, Demirel A, Tahan V. · No affiliation provided · Dig Dis Sci. · Pubmed #18409062 No free full text.

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Tahan V, Tahan G, Dane F, Uraz S, Yardim M. · No affiliation provided · J Gastrointestin Liver Dis. · Pubmed #17592576 links to  free full text

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Ozdogan O, Tahan V, Cincin A, Imeryuz N, Tozun N. · No affiliation provided · Pancreas. · Pubmed #17446854 No free full text.

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Eren F, Tahan V, Ozdemir F, Akin H, Tozun N. · No affiliation provided · J Gastrointestin Liver Dis. · Pubmed #17013460 No free full text.

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Tahan V, Yildirim B, Ture F, Giral A, Ozdogan O, Imeryuz N, Avsar E, Mert A, Senturk H, Kalayci C, Tozun N. · No affiliation provided · J Clin Gastroenterol. · Pubmed #14679341 No free full text.

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Tahan V, Ozaras R, Uzunismail H, Mert A, Tabak F, Ozturk R, Aktuglu Y, Ozbay G. · No affiliation provided · J Clin Gastroenterol. · Pubmed #11418805 No free full text.

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