Browsing by Author "Ensari, Arzu"

Now showing 1 - 9 of 9
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    Complete remission of nephrotic syndrome in secondary amyloidosis of familial Mediterranean fever following colchicine treatment
    (2005) Düzgün, Nurşen; Şahinalp, Mehmet Sait; Akar, M. Nejat; Kuzu, Işınsu; Ensari, Arzu; Tulunay, Özden
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    Diagnosing celiac disease: A critical overview
    (2019) Ensari, Arzu; Tıp Fakültesi
    The diagnosis of celiac disease (CD) no longer rests on a malabsorptive state or severe mucosal lesions. For the present, diagnosis will always require the gold-standard of a biopsy, interpreted through its progressive phases (Marsh classification). Marsh classification articulated the immunopathological spectrum of gluten-induced mucosal changes in association with the recognition of innate (Marsh I infiltration) and T cell-based adaptive (Marsh II, and the surface re-organisation typifying Marsh III lesions) responses. Through the Marsh classification the diagnostic goalposts were considerably widened thus, over its time-course, permitting countless patients to begin a gluten-free diet but who, on previous criteria, would have been denied such vital treatment. The revisions of this classification failed to provide additional insight in the interpretation of mucosal pathology. Morever, the subclassification of Marsh 3 imposed an enormous amount of extra work on pathologists with no aid in diagnosis, treatment, or prognosis. Therefore, it should now be apparent that if gastroenterologists ignore these sub-classifications in clinical decision-making, then on that basis alone, there is no need whatsoever for pathologists to persist in reporting them. Since new treatments are under critical assessment, we might have to consider use of some other higher level histological techniques sensitive enough to detect the changes sought. A promising alternative would be to hear more voices from imaginative histopathologists or morphologists together with some more insightful approaches, involving molecular-based techniques and stem cell research may be to evaluate mucosal pathology in CD.
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    Early colon carcinoma of the appendix associated with adenomatous polyposis coli: a case report
    (2005) Köseoğlu, R. Doğan; Ensari, Arzu; Ayva, Yaşar
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    Kolorektal kanser ve öncü lezyonlarında KRAS ve BRAF mutasyon analizleri yoluyla tanısal yaklaşım ve hedefe yönelik tedavi seçimi
    (Biyoteknoloji Enstitüsü, 2011) Erdoğan, Öznur; Ensari, Arzu; Biyoteknoloji
    Colorectal carcinoma is one of the leading causes of cancer death in the Western world and its incidence has been increasing in our country. In order to have a successful therapeutic approach to colorectal carcinoma, both the precursor lesions and also the molecular background of neoplastic progression need to be evalauated. In recent years, it was shown that colorectal carcinomas showing activating mutations in the KRAS gene (30-40% of the cases) are unresponsive to anti-EGFR therapy and that KRAS mutation analysis could predict patients for appropriate targeted therapy.In the present thesis, different precursor lesions of colorectal carcinoma (87 cases) together with the carcinoma cases (40 cases) were evaluated for KRAS and BRAF mutations in an attempt to correlate the morphologic findings with molecular results. Morphologic classificiaton was perfomed on the H&E sections where the lesion was marked with a marker pen to identify the area for DNA extraction. Following manual microdissection of these areas, DNA was isolated. KRAS mutation was assessed for exon 2 codon 12 ve 13, exon 3 codon 61 using pyrosequencing while BRAF mutations were evalauated using allele specific PCR and confirmed with DNA sequencing.Our results showed that, BRAF, together with KRAS, seem to play a significant role in colorectal neoplastic progression and in the development of serrated precursors of colorectal carcinoma, in particular. These findings suggest that BRAF may be used as a predictor in the targeted therapeutic approach to colorectal cancer patients.
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    Mesalamine Intolerance in Three Children with Crohn's Disease
    (2016) Kirsaclioglu, Ceyda Tuna; Kuloglu, Zarife; Ustundag, Gonca; Kansu, Aydan; Ince, Erdal; Ensari, Arzu; Girgin, Nurten; TIP FAKÜLTESİ
    Objective: To present the mesalamine-induced acute exacerbation of symptoms and inflammatory markers in children with Crohn's disease (CD). Clinical Presentation and Intervention: Three children who presented with CD had acute exacerbation of colitis symptoms or elevated inflammatory markers when mesalamine was added to treatment while tapering/ceasing steroid treatment. While on steroid treatment, the patients maintained clinical and laboratory remission, but with the initiation of mesalamine treatment, they had abdominal pain and bloody mucoid diarrhoea and/or elevation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Bacterial pathogens were excluded from the urine, throat and blood cultures, parasites with stool examination, viral pathogens with serology. Within 3-7 days after the mesalamine treatment had been stopped, the patients showed improvement of colitis symptoms and normalisation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Conclusion: In this study mesalamine mimicked CD relapse in children with CD while tapering or after stopping steroid treatment. Awareness of this side effect of mesalamine could prevent a misdiagnosis of steroid dependency. (C) 2015 S. Karger AG, Basel
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    Mesalamine intolerance in three children with Crohn’s disease
    (2015) Tuna Kırsaçlıoğlu, Ceyda; Kuloğlu, Zarife; Üstündağ, Gonca Handan; Tanca, Aydan; İnce, Erdal; Ensari, Arzu; Girgin, Nurten; Tıp Fakültesi
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    Mide karsinomlarında PD-1 ve PD-l1 ekspresyonunun prognostik parametreler ve sağkalımla ilişkisi
    (Sağlık Bilimleri Enstitüsü, 2017) Arman, Ahmet Faruk; Ensari, Arzu; Tıbbi Patoloji
    Son yıllarda tümöre karşı daha iyi bir immün yanıtın oluşturulabilmesine yönelik immün tedavilerin geliştirilmesi, bu tedavilerden en yüksek yararı görecek hasta gruplarının belirlenmesini sağlayacak biyobelirteçlerin ortaya konmasını sağlamıştır. Bunlar arasında yer alan PD-1, immünite ve tolerans süreçlerinde T hücre işlevlerinin düzenlenmesinde önemli görevleri bulunan bir koreseptör proteindir ve PD-L1 ve PD-L2 olarak adlandırılan ve tümör hücrelerinde de eksprese edilebilen iki ligandı bulunmaktadır. Tam bir görüş birliği olmamakla birlikte, bazı çalışmalarda PD-L1 ekspresyonunun mide kanserlerinde, hedefe yönelik tedavilere yanıtı öngören, prediktif bir biyobelirteç olabileceği sonucuna ulaşılmıştır. Bu çalışmada, 220 mide kanseri tanısı almış olguya ait rezeksiyon materyallerinden elde edilen tümör dokularında, tümör mikroçevresinin önemli komponentlerinden biri olan tümör infiltre eden lenfositlerin (TİL) yoğunluğu ve immünhistokimyasal olarak PD-1 ve PD-L1 ekspresyonlarının klinikopatolojik prognostik faktörler ve sağkalımla ilişkileri araştırılmıştır. Olguların stromal TİL yüzdeleri ile tümör hücrelerindeki PD-L1 boyanma yüzdeleri arasında bir ilişki saptanmazken, intratümöral TİL varlığında tümörde PD-L1 pozitifliği daha sık olarak gözlenmiş ve bu olgularda tümörde PD-L1 boyanma yüzdeleri anlamlı olarak yüksek bulunmuştur. Benzer olarak immün hücrelerde PD-L1 ekspresyonu gösteren olgularda, bulundurmayan olgulara göre stromal TİL yüzdeleri anlamlı olarak yüksek bulunmuştur. İntratümöral ve invazyon sınırında TİL bulunduran olgularda, bulundurmayanlara göre, immün hücrelerdeki PD-L1 ve PD-1 boyanma yüzdeleri yüksek olarak izlenmiştir. Stromal TİL yüzdeleri ile immün hücrelerdeki PD-L1 boyanma yüzdeleri arasında korelasyon izlenmezken, PD-1 ile stromal TİL yüzdesinin korele olduğu görülmüştür. PD-L1 ve PD-1 ekspresyonları sağkalım açısından değerlendirildiğinde, tümör hücrelerinde PD-L1 pozitifliği gösteren olgularda ortalama sağkalım süresi, diğer olgulara göre anlamlı olarak daha uzun bulunmuştur. Sonuçlarımız, literatür eşliğinde değerlendirildiğinde, PD-L1 ve PD-1 ekspresyonlarının immünterapiden yarar görebilecek hasta gruplarının belirlenmesi ve olguların prognostik değerlendirmesine katkı sağlayabileceği düşünülmüştür.
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    Sporadik kolorektal kanser ve prekürsör lezyonlarda RAS arayolunun değerlendirilmesi
    (Sağlık Bilimleri Enstitüsü, 2012) Kadan, Elçin; Ensari, Arzu; Other
    In recent years, for metastatic disease, in particular, targeted anti-EGFR therapy is becoming the treatment of choice for colorectal carcinoma. It is crucial to determine the appropriate molecular markers and to select the patients for therapy to achieve the best result. Tumor resistance to the limited targeted therapy agents and the low cost-effectivitiy increase the need to find new molecular targets for therapy. PI3K/AKT/mTOR and MAPK pathway molecules are the most frequently studied potential agents for targeted therapy. In our study, a large series of cases grouped according to the polyp-carcinoma sequence were analysed for molecules involved in MAPK and PI3K pathways using tissue array and immunohistochemistry in order to evaluate their role in the sequence. Our results showed that MEK1 expression was higher in carcinomas compared to polyps in contrast to ERK1 and ERK2. pAKT expression significantly decreased from carcinomas to adenomatous polyps and serrated polyps. There was a significant correlation between the increased expression of AKT and the size of polyps. mTOR expression was higher in adenomatous polyps than in carcinomas and the expression levels increased with the size of polyps.In conclusion, our results suggest that, pAKT, mTOR, MEK1, ERK1 and ERK2 seem to take place in the early stages of colorectal carcinogenesis. These results may have an important impact on the current literature since our study was designed so that both adenomatous and serrated neoplastic sequences were represented by large numbers of cases allowing a thorough evaluation.
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    Tıbbi Patoloji Dönem 3 Ders Sunumları
    (2017) Ensari, Arzu