The use of fully covered self-expandable metal stents in the endoscopic treatment of portal cavernoma cholangiopathy

BACKGROUND AND AIMS

There are different therapeutic approaches for biliary strictures and reducing portal hypertension in patients with symptomatic portal cavernoma cholangiopathy (PCC). Endoscopic treatment includes endoscopic biliary sphincterotomy (EST), dilation of stricture with a biliary balloon, placement of plastic stent(s) and stone extraction. Fully covered self-expandable metal stent (FCSEMS) is placed as a rescuer in case of haemobilia seen after EST, dilation of stricture and removal of plastic stent rather than the stricture treatment itself. In this retrospective observational study, we sought to assess the clinical outcomes of FCSEMS as the initial treatment for PCC-related biliary strictures.

MATERIALS AND METHODS

Twelve symptomatic patients with PCC both clinically and radiologically between July 2009 and February 2019 were examined. Magnetic resonance cholangiopancreatography (MRCP) and cholangiography were employed as the diagnostic imaging methods. Chandra-Sarin classification was used to distinguish between biliary abnormalities in terms of localization. Llop classification was used to group biliary abnormalities associated with PCC. Endoscopic partial sphincterotomy was performed in all the patients. If patients with dominant strictures 6-8-mm balloon dilation was first performed. This was followed by removal of the stones if exist. Finally, FCSEMS placed. The stents were removed 6-12 weeks later.

RESULTS

The mean age of the patients was 40.9 ± 10.3 years, and 91.6% of the patients were male. Majority of the patients (n = 9) were noncirrhotic. Endoscopic retrograde cholangiopancreatography (ERCP) findings showed that 11 of the 12 patients were Chandra Type I and one was Chandra Type IIIa. All the 12 patients were Llop Grade 3. All patients had biliary involvement in the form of strictures. Stent placement was successful in all patients. FCSEMSs were retained for a median period of 45 days (30-60). Seven (58.3%) patients developed acute cholecystitis. There was no occurrence of bleeding or other complications associated with FCSEMS replacement or removal. All patients were asymptomatic during median 3 years (1-10) follow up period.

CONCLUSIONS

FCSEMS placement is an effective method in biliary strictures in case of PCC. Acute cholecystitis is encountered frequently after FCSEMS, but majority of patients respond to the medical treatment. Patients should be followed in terms of the relapse of biliary strictures.

CHRM3-Associated miRNAs May Play a Role in Bile Acid-Induced Proliferation of H508 Colon Cancer Cells

BACKGROUND

It was well defined that proliferative effects of bile acids on colon epithelium are through interaction with muscarinic-3 receptors. Recently, microRNA emerged as an important regulator of gene expression and has been implicated in pathogenesis of many malignancies. However, the interaction of CHRM3 and microRNAs and their potential effects on colon carcinogenesis remains to be elucidated.

METHODS

In the current study, analysis of cell proliferation for 6 days after treatment with sodium taurolithocholate was analyzed by using WST-1 method. microRNAs which possibly target CHRM3 were identified by in silico analyses. Expression profiling of these microRNAs, expression changes of CHRM3 gene at mRNA level for H508 and SNU-C4 colon cancer cells were analyzed by quantitative polymerase chain reaction; the protein level of CHRM3 was analyzed using Western blot; apoptotic experiments were analyzed using the Annexin V assay. The Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using the miRPath v3.0.

RESULTS

It was found that the expression level of CHRM3 gene was 6.133 ± 0.698-fold in H508 cells compared with SNU-C4 cells (P =.004). Treatment of H508 cells with sodium taurolithocholate caused 1.34 ± 0.4156-fold change in the expression level of CHRM3 gene (P =.0448). No apoptotic changes were observed in both colon cancer cells after treatment with sodium taurolithocholate. Different expression changes were detected of hsa-miR-129-5p, hsa-miR-30c-5p, hsa-miR-224-5p, hsa-miR-30b-5p, hsa-miR-522-3p, and hsa-miR-1246. Finally, hsa-miR-1246 and hsa-miR-522-3p could play a critical role in tumor development via bile acid-related genes in colon cancer.

CONCLUSION

These findings reflected that CHRM3-dependent oncogenetic pathways might be in charge of colon cancer. We suggest that the microRNA expression profile of each individual colon cancer tissue is a unique digital signature.

Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II endoscopic retrograde cholangiopancreatography-related perforations

Background

Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but life-threatening complications. The treatment of Type-II-periampullary perforations that develop during endoscopic sphincterotomy remains a topic of discussion. This study aimed to evaluate the usefulness of fully covered self-expanding metal stenting (FCSEMS) for treating Type-II perforations.

Methods

The files of all patients who underwent the ERCP procedures between January 2015 and October 2021 were retrospectively reviewed; patients with Stapher Type-II perforation were included in the current study. Patients with FCSEMS were classified into two groups: those who underwent FCSEMS and those who were conventionally followed up. Moreover, patients with FCSEMS were classified into two subgroups: those who underwent simultaneous stenting and those who underwent late stenting. Mortality, surgical intervention, percutaneous drainage, length of hospital stay, and inflammatory markers were all compared between the groups.

Results

Of the 9253 patients undergoing ERCP during the study period, 28 patients (0.3%) were found to have Type-II perforation. The mean age of these patients was 67.7 ± 3.9 years, and 15 patients were female. FCSEMS was performed on 19 patients, whereas 9 patients were on conventional follow-up. None of the patients developed mortality. In the conventional follow-up group, one patient required percutaneous drainage and one required surgical intervention. In contrast, none of the patients in the FCSEMS group required additional intervention. At a statistically significant level, the length of hospital stay was found to be shorter in the FCSEMS group. There was no difference in inflammatory markers between the two groups. In nine patients, FCSEMS was performed simultaneously, whereas, in ten patients, FCSEMS was performed later because they required a second intervention. These two subgroups did not differ in terms of outcomes.

Conclusions

FCSEMS is a safe and effective treatment modality for patients with Type-II perforation. Moreover, it can be safely used in patients whose perforations are diagnosed during the ERCP procedure and in patients whose diagnoses are made after the procedure.

Association Between Known Close Contact History and Severity of COVID-19 Pneumonia: A Preliminary Evidence Supporting Importance of Filiation

OBJECTIVE:

The role of a known contact history in coronavirus disease 2019 severity in secondary cases is unknown. The study was aimed to investigate the relationship between the close contact history and the severity of the disease in coronavirus disease 2019 pneumonia.

MATERIAL AND METHODS:

Hospitalized patients diagnosed with coronavirus disease 2019 pneumonia were included. The demographic, clinical, and laboratory data of the patients were collected retrospectively and patients with or without close contact history were analyzed with respect to the severity of pneumonia.

Results:

In a total of 100 patients with coronavirus disease 2019 pneumonia, 54 (54%) were male and mean age was 42.28 ± 17.13 years. Respiratory rate/min (P = .033) was higher, duration of hospitalization (P = .043) was longer, need for oxygen therapy (P < .001), intensive care unit admission (P = .001), and severe pneumonia (P < .001) were higher in the group without a close contact history (n = 50). Male gender (OR, 4.77; 95% CI, 1.06-21.32; P = .041), not having a close contact history (OR, 4.03; 95% CI, 1.00-16.13; P = .049), non-hospital-associated patients (OR, 9.59; 95% CI, 1.47-62.41; P = .018), and dyspnea (OR, 7.58; 95% CI, 1.64-34.93; P = .009) were found to be risk factors for severe pneumonia.

Conclusion:

Known close contact history was associated with non-severe pneumonia and was found to be an independent predictor of disease severity in coronavirus disease 2019 pneumonia. The study provides evidence that filiation may prevent severe disease.

Improvement of Work Productivity and Quality of Life with Anti-Tumor Necrosis Factor Treatment Used in Crohn's Disease in Routine Clinical Practice in Turkey

BACKGROUND

Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36.

METHODS

Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study.

RESULTS

A total of 106 patients were included in this study, and 64.2% of the patients were males. Mean [± standard deviation] age was 36.8 [± 10.9] years. At baseline, mostly perianal fistulas [65.7%] were observed [n = 23]. Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%]. Extraintestinal symp- toms were observed in 24 patients [22.6%]. Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15]. Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years. Improvements in work productivity and activ- ity impairment scores throughout 12 months were -24.1% [P = .003] for work time missed, -18.0% [P = .006] for impairment at work, -8.5% [P = .160] for overall work impairment, and -17.0% [P < .001] for daily activity impairment. Similarly, significant improvements [P < .001] were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline. Statistically sig- nificant improvements [P < .05] were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095].

CONCLUSION

Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.

Effectiveness of a Telerehabilitative Home Exercise Program on Elder Adults’ Physical Performance, Depression and Fear of Falling

Our aim in this study was to analyze the effects of a home exercise program of calisthenic exercises delivered through telerehabilitation on physical performance, depression, and risk of falling in elder adults. Our participants were elder adults aged 65 and over, divided into exercise and control groups. We initiated a 4-week telerehabilitation calisthenic exercise program in the exercise group following initial assessments, while our control group received no formal exercise training. Both groups were evaluated online before and after this 4-week period with the Geriatric Depression Scale (GDS), Modified Falls Efficacy Scale (MFES), and Short Physical Performance Battery (SPPB). In total, 255 elder adults participated, with 132 (males = 72, females = 60) allocated to calisthenic exercise and 123 (males = 66, females = 57) allocated to the control group. While the groups did not differ significantly on any of our parameters before the exercise, there were statistically significant post-exercise group differences in GDS ( p ≤ .001) and MFES ( p ≤ .001) scores related to remarkable physical improvements achieved in the calisthenic exercise group. The exercise group showed significant increases in their scores on the SPPB Balance Test ( p = .049), SPPB Chair Test ( p = .009), and SPPB Total ( p = .002) while there was no significant increase in any of these scores among control group participants ( p > .05). Thus, calisthenic exercises performed via telerehabilitation significantly improved elder adults’ physical performance, fear of falling, and depression. Telerehabilitation is a useful remote means of assessing, inducing, and following-up exercise training, particularly during the ongoing COVID-19 pandemic.

Pazopanib-induced chylothorax in a patient with renal cell carcinoma

Pazopanib is an oral multi-kinase inhibitor approved for the treatment of advanced renal cell carcinoma (RCC). It is an anti-angiogenic agent, which blocks the activation signaling pathways of tyrosine kinases and prevents the activities of primarily vascular endothelial growth factor receptors (VEGFR)-2 and VEGFR-3, which are important in lymphangiogenesis. Herein, we report a patient with advanced RCC who developed asymptomatic left-sided chylothorax under pazopanib therapy. Chylothorax developed in the 16th month and gradually increased until it was diagnosed by thoracentesis in the 22nd month. The development of chylothorax was attributed to pazopanib therapy after ruling out all possible traumatic and nontraumatic etiologies. The 'Adverse Drug Reaction Probability Scale' revealed a total score of 6, which fell into 'probable' category. Chylothorax regressed significantly 5 weeks after the discontinuation of pazopanib therapy.

Evaluation of the validity and reliability of the KFORCE Sens® electrogoniometer in evaluation of wrist proprioception

The aim of this study was to determine the validity and reliability of the KFORCE Sens® electrogoniometer in the evaluation of wrist proprioception. Wrist position sense was assessed on a Baseline® 360° universal goniometer and a KFORCE Sens® device. The validity and reliability of the KFORCE Sens® device for wrist position sense evaluation were investigated by comparing the two data sets. Fifty-three healthy volunteers (39 female, 14 male) with a mean age of 22.83 ± 1.28 years (range, 21-27 years) were included. Joint position sense test-retest reliability (intra-class correlation coefficient) on KFORCE Sens® was "very good" for all wrist movements. There was a very strong correlation between flexion-extension movements on the dominant side (r = 0.955), and a strong correlation between ulnar-radial deviation movements (r = 0.745). There was also a very strong (r = 0.863) correlation between flexion-extension movements on the non-dominant side and a strong correlation (r = 0.690) between ulnar-radial deviation movements (p < 0.05). Our results showed that the KFORCE Sens® device was a valid and reliable evaluation means of assessing wrist position sense.

Effectiveness of Extracorporeal Shock Wave Therapy on Postural Control and Balance in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial

The aim of this study was to investigate the effects of Extracorporeal Shock Wave Therapy (ESWT) applied to paraspinal muscles on balance and postural control in children with unilateral Cerebral Palsy (CP). A total of 32 children with unilateral CP were included in the study. The children participated in a one-session control to evaluate their reactions to ESWT before randomly assigning them into experimental and control groups. We evaluated children twice: before and after the treatment. We used the Trunk Control Measurement Scale, Trunk Impairment Scale, Pediatric Balance Scale (PBS), and Timed Up and Go (TUG) test in these assessments. Following the pre-test session, we applied Neuro-Developmental Treatment (NDT) programs to both groups at the rate of twice per week for eight weeks; additionally, we applied ESWT only to the experimental group at the rate of twice a week for eight weeks. While there were trends toward increased trunk control skills, PBS scores and TUG test performances from pre- to post-testing in both groups, these improvements were only statistically significant in the experimental group (p < 0.05). We conclude that for children with unilateral CP, ESWT applied to paraspinal muscles has significant additive value when combined with NDT to improve postural control and balance.

Factors related to oxygen desaturation during flexible bronchoscopy and endobronchial ultrasound

Introduction

Oxygen desaturation is a significant event during bronchoscopy. In this study, it was aimed to identify factors related to oxygen desaturation during flexible bronchoscopy (FB) and Endobronchial ultrasound (EBUS).

Materials and Methods

From 16 April 2019 to 14 February 2020, 196 consecutive patients (146 FB and 50 EBUS) undergoing bronchoscopy were evaluated retrospectively. The patients' oxygen saturations were monitored on admission and during the procedure by finger pulse oximetry. Desaturation was defined as saturation below 90%. Demographic characteristics, comorbidities, types of interventions, vitals before and during the procedure, amount of saturation decline, and sedative agents used were recorded. The data obtained were compared between the desaturated and non-desaturated groups in both FB and EBUS. We evaluated the risk factors for desaturation during bronchoscopic procedures.

Result

The mean age of those who underwent FB was higher (62 [52-68] years vs. 55 [44-65] years, p= 0.05), and males were more frequent (54%, vs 19.2%, p<0.001) in the desaturated group. In FB, short lavage was more frequent in the non-desaturated group (28.8% vs. 9.5%, p<0.001). In EBUS, hypertension, diabetes mellitus and thyroid diseases were higher, and duration of procedure was longer (p= 0.02, p= 0.04, p= 0.01 and p<0.001 and p= 0.01, respectively), and SpO2 decline during procedures was higher (11% vs. 1% in FB, 18% vs. 3% in EBUS, p<0.001, each) in the desaturated group.

Conclusions

This study suggested that baseline SpO2 and SpO2 decline during procedures as well as sex, hypertension, and concomitant endocrine - metabolic diseases, duration of procedure were factors associated with desaturation in patients who had undergone FB and EBUS.

Short and Long-Term Effects of Whole-Body Vibration on Spasticity and Motor Performance in Children With Hemiparetic Cerebral Palsy

This study aimed to investigate the short and long-term effects of Whole-Body Vibration (WBV) therapy on spasticity and motor performance in children with hemiparetic cerebral palsy. We recruited 26 patient participants from among children undergoing conventional physiotherapy in a private rehabilitation center. We randomly assigned 22 participants to equally sized treatment (n = 11) and control (n = 11) groups. We evaluated the participants at the beginning of the study with the Gross Motor Function Measure-88, LEGSys™ Spatio-Temporal Gait Analyzer, SportKAT550™ Portable Computerized Kinesthetic Balance Device and the Modified Ashworth Scale. While children in the treatment group were treated with Compex-Winplate™ to administer WBV in three 15-minute sessions per week for eight weeks, children in the control group received continued conventional physiotherapy during this period. We then re-evaluated all participants both immediately after the treatment and again 12 weeks after the treatment. Following WBV, both gross motor functions and gait and balance skills were significantly improved (p < 0.05), and spasticity in lower and upper extremity muscles was significantly inhibited (p < 0.05). These improvements were preserved even after 12 weeks. We conclude that WBV is an effective incremental approach to conventional physiotherapy in children with hemiparetic cerebral palsy for inhibiting spasticity and improving motor performance.

Growing-rod Graduates With Idiopathic Early-onset Scoliosis Have Comparable Exercise Tolerance to Patients With Surgically Treated Adolescent Idiopathic Scoliosis

BACKGROUND

Growing-rod (GR) treatment is the current standard for progressive idiopathic early-onset scoliosis (I-EOS) in young children. Despite good radiographic outcomes, the impact of scoliosis treatment on pulmonary functions is not well-defined in this patient population. The aim of this study was to evaluate pulmonary functions and exercise tolerance in I-EOS patients graduated from GR treatment and to compare them with age-matched, surgically treated adolescent idiopathic scoliosis (AIS) patients and healthy controls.

METHODS

Eight GR graduates with I-EOS with pulmonary function tests and complete radiographic results were compared with a group of 9 thoracic AIS patients at least 2 years out from posterior fusion. Both groups were also compared with a set of 10 healthy individuals. All subjects underwent cardiopulmonary exercise testing and spirometry to evaluate pulmonary function.

RESULTS

Age, sex, height, arm span, weight, residual deformity, and level of instrumentation in GR and AIS patients were similar. In the GR group, forced vital capacity % and forced expiratory volume in 1 second % values were reduced compared with the healthy controls and AIS group (P<0.001, <0.001 and 0.036, 0.046, respectively). Breathing reserve index at lactate threshold (BRILT) was higher in GR and AIS patients (P=0.001 and 0.002, respectively), and was similar between GR and AIS patients (P=0.916). Heart rate at lactate threshold was higher in GR and AIS groups compared with controls (P<0.001 and 0.001, respectively).

CONCLUSIONS

AIS and GR patients demonstrated reduced pulmonary reserve and exercise tolerance compared with their peers with no spinal deformity. However, exercise tolerance of I-EOS patients treated with the GR method was similar to that of operated AIS patients. These results suggest a positive impact of GR treatment in children with I-EOS.

LEVEL OF EVIDENCE

Level III-cross-sectional comparative study.

Changing patterns of upper gastrointestinal bleeding over 23 years in Turkey

BACKGROUND/AIMS

This study aimed to compare the causes of nonvariceal upper gastrointestinal bleeding (NVUGB), demographics, risk factors, and outcomes of patients during two periods between 1993 and 2016 in a tertiary health-care center in Turkey.

MATERIALS AND METHODS

We compared the causes of NVUGB and clinical outcomes in 421 patients hospitalized between January 1993 and December 1995 with those of 231 patients with NVUGB hospitalized between January 2015 and September 2016. We also compared epidemiological characteristics, risk factors, and the rates of endoscopic hemostatic procedures.

RESULTS

We observed significant increases in patients' mean age, in the percentage of patients with comorbid conditions, and in the percentage of patients who received direct-acting oral anticoagulants before bleeding. We also observed a statistically nonsignificant increase in the diagnoses of gastric ulcer, along with a significant concordant decrease in diagnoses of duodenal ulcer as a cause of bleeding. The use of emergency surgical hemostasis decreased among cases of peptic ulcer bleeding. The overall rate of mortality from bleeding did not significantly change between the two periods.

CONCLUSION

Over the 23 years studied, the causes of NVUGB changed, probably because the population was increasingly elderly population and because of the use of anticoagulants and better therapeutic approaches to chronic duodenal ulcers. The use of emergency surgical hemostasis reduced, but mortality rate did not significantly change between the two specific periods.

Real-life experience of ledipasvir and sofosbuvir single-tablet regimen among chronic hepatitis C patients in Turkey

BACKGROUND/AIMS

Ledipasvir (LDV) and sofosbuvir (SOF) as single-tablet regimen (STR) has been approved for treatment of chronic HCV infection (CHC) for treatment-naïve or experienced cirrhotic or non-cirrhotic patients. Our aim was to analyse the effectiveness and safety of 12-24 weeks treatment of LDV/SOF (90mg/400 mg)±ribavirin in a real-life setting in Turkey.

MATERIALS AND METHODS

Between May-Dec 2016, 104 treatment-naïve or experienced adult patients with CHC and with or without cirrhosis (including decompensated cirrhosis) were included in this observational study. Patients were administered LDV/SOF STR± ribavirin once daily for 12 -24 weeks. SVR12 rates and effects of the baseline characteristics on SVR12 rates were assessed.

RESULTS

Out of 104 enrolled patients (61.5% female, mean age 62.0 years); 60.6% were cirrhotic, 76.0% previously used peg-IFN, 94.2% had GT1. At the end of the treatment, 77.8% (77/99, no data for 21 patients) had undetectable HCV-RNA and 98.9% (94/95) had SVR12. In the baseline characteristics subgroups, the SVR12 rates varied between 94.4% and 100%, and none of the baseline characteristics had a significant effect on the SVR12 rates. During the study, 6 (5.8%) patients died and none of the deaths was suspected to be related to the LDV/SOF. No treatment-emergent adverse event was reported.

CONCLUSION

In conclusion, LDV/SOF±ribavirin yielded very high SVR12 rates, without any safety or tolerability concern in Turkey. The effectiveness of the LDV/SOF treatment was not affected by the patient demographics or medical characteristics such as fibrosis level, cirrhosis status, previous treatment status, HCV-RNA level or HCV genotype.

Examining various factors affecting communication skills in children with cerebral palsy

BACKGROUND AND OBJECTIVE

Cerebral palsied children may have difficulties in acting as senders and/or receivers in the communication process. The aim of this study is examining that which maternal and child-related factors affect the communication skills of cerebral palsied children.

METHODS

188 cerebral palsy diagnosed children ages between 2-18 years were assessed by Communication Function Classification System for communication skills. Maternal factors such as occupation, and educational status, and child-related factors such as gender, time of birth, clinical type of cerebral palsy, origin period of cerebral palsy; also daily living activities and gross motor functions of children were included in the assessment for examining how they affect the communication skills of cerebral palsied children.

RESULTS

Lower maternal age, higher gross motor function level, ataxic type and hemiparetic involvement (p < 0,05); educational status, maternal unemployment, female gender, and premature birth (p > 0,05) affected positively on the communication skills. There were no effects of delivery method (p > 0,05).

CONCLUSIONS

Communication skills of cerebral palsied children are affected by maternal age, educational status, occupation, and child's gender, birth term, origin period of cerebral palsy, clinical type of cerebral palsy, extremity involvement, motor development level and gross motor function. But the method of delivery has no effect on the communication functions of cerebral palsied children.

Colorectal cancer and dysplasia risk of ulcerative colitis patients in a tertiary referral center in Turkey

BACKGROUND/AIMS

Patients with ulcerative colitis (UC) are at increased risk of colorectal cancer (CRC). High-grade dysplasia (HGD) and low-grade dysplasia (LGD) are premalignant conditions. The aim of this study is to evaluate the risk of CRC/dysplasia in patients with UC, and the related risk factors.

MATERIALS AND METHODS

Medical records of 1659 patients dating between 1993 and 2016 were scanned from an inflammatory bowel disease database. A total of 801 patients with UC who underwent at least one colonoscopic procedure with at least 1-year follow-up period were included in the study. Clinical, endoscopic, and histopathological data were assessed.

RESULTS

The mean disease duration was 6.7±6.6 years. The total disease duration was 5334 person-years duration (pyd), and 34% of patients had the disease for 8 years or longer. The prevalence of UC-associated CRC was 0.7%, and the prevalence of dysplasia was 0.85%. The overall incidence of CRC was determined to be 1.1/1000 pyd. The cumulative risk of CRC was 0.3% at 10 years, 1.3% at 20 years, and 5.9% at 30 years. The Cox regression analysis indicated that primary sclerosing cholangitis (HR:13.677, 95% CI:2.6-70.8, p = 0.012) was an independent risk factor for developing UC-associated CRC.

CONCLUSION

This study underlined the low risk of CRC and dysplasia in patients with UC in a tertiary referral center in the western part of Turkey. Primary sclerosing cholangitis was found to be the most important risk factor for the development of CRC in patients with UC. Identification of risk factors is important to categorize patients into subgroups to know which patients will require frequent surveillance.

Results of 1001 liver transplantations in 23 years: Ege University experience

BACKGROUND/AIMS

Liver transplantation (LT) is now the standard of care for most end-stage liver diseases. Over the next 30 years, advances in medicine and technology will greatly improve the survival rates of patients after this procedure. The aim of the present study was to analyze retrospectively the results of 1001 patients withLT.

MATERIALS AND METHODS

Medical reports of 989 patients were analyzed retrospectively. Data were obtained from the patient's data chart. Descriptive statistics were used to describe continuous variables (mean, median, and standard deviation).

RESULTS

A total of 1001 LTs for 989 recipients were performed at Ege University Organ Transplantation and Research Center between 1994 and 2017. Therewere 639 male and 350 female recipients. Among 1001 LTs, there were 438 deceased donors and 563 living donors. The age interval of the patients was 4 months to 71 years old. The median Model for End-Stage Liver Disease score was 20. There were 12 deceased liver donors using the split method. There were 12 cases subject to retransplantation. In living donor LT grafts, 423 right lobes, 46 left lobes, and 94 left lateral sectors were used. In the first monitoring,the total annual mortality rate was 130 cases (13%). The mortality rate in retransplantation was found to be 66%. A 1-year survival rate of 87% was generally stablished.

CONCLUSION

LThas been improving consistently over the last two decades. Ege University is one of the biggest liver transplant centers in Turkey for both technical and educational perspective.

Effectiveness of Neuro-Developmental Treatment (Bobath Concept) on postural control and balance in Cerebral Palsied children

BACKGROUND AND OBJECTIVE

The aim of this study was to show the effects of an 8-week Neurodevelopmental Treatment based posture and balance training on postural control and balance in diparetic and hemiparetic Cerebral Palsied children (CPC).

METHODS

Fifteen CPC (aged 5-15 yrs) were recruited from Denizli Yağmur Çocukları Rehabilitation Centre. Gross Motor Function Classification System, Gross Motor Function Measure, 1-Min Walking Test, Modified Timed Up and Go Test, Paediatric Balance Scale, Functional Independence Measure for Children and Seated Postural Control Measure were used for assessment before and after treatment. An 8-week NDT based posture and balance training was applied to the CPC in one session (60-min) 2 days in a week.

RESULTS

After the treatment program, all participants showed statistically significant improvements in terms of gross motor function (p< 0.05). They also showed statistically significant improvements about balance abilities and independence in terms of daily living activities (p< 0.05). Seated Postural Control Measure scores increased after the treatment program (p< 0.05).

CONCLUSIONS

The results of this study indicate that an 8-week Neurodevelopmental Treatment based posture and balance training is an effective approach in order to improve functional motor level and functional independency by improving postural control and balance in diparetic and hemiparetic CPC.

Paper #3: Can TGR change the natural history of pulmonary functions in EOS? Is Radiological Straightness Correlated with Normal Lung Development?

Even though traditional growing rod (TGR) patients score lower in exercise tolerance and spirometry compared to age-matched controls, their pulmonary functions are similar to those of instrumented adolescent idiopathic scoliosis (AIS) patients.

Is there any difference in tetanus IgG levels of diabetic patientswith respect to the presence of foot ulcers?

BACKGROUND/AIM

The aim of this study was to reveal the tetanus immunization status of diabetic patients and to determine whether diabetic patients with foot ulcers have different TIG levels.

MATERIALS AND METHODS

A cross-sectional study was designed that included diabetic patients with foot ulcers (n = 30) and diabetic patients without ulcers (n = 30). The groups were compared for serum TIG levels along with total serum protein, albumin, C-reactive protein (CRP), and total immunoglobulin G (Ig G).

RESULTS

For diabetic patients without foot ulcers, 17 of 30 (56.6%) patients were found to have nonprotective TIG levels whereas for diabetic patients with foot ulcers, 28 of 30 (93.3%) patients were found to have nonprotective TIG levels. The mean value of TIG for diabetic patients without foot ulcers was 0.345 ± 0.281 IU/mL and for diabetic patients with foot ulcers the mean TIG value was 0.055 ± 0.033 IU/mL. Statistically significant differences were observed in TIG (P = 0.008), total protein (P < 0.001), albumin (P < 0.001), and CRP levels (P < 0.001) between the two groups.

CONCLUSION

The majority of the diabetic patients had low TIG levels and they were significantly lower in diabetic patients with ulcers. A booster dose of tetanus vaccine should be considered for diabetic patients with and without diabetic foot ulcers.

Magnetic compression anastomosis for patients with a disconnected bile duct after living-donor related liver transplantation: a pilot study

BACKGROUND AND STUDY AIM

We present the use of the magnetic compression anastomosis (MCA) technique for treatment of disconnected bile duct after living-donor related liver transplantation (LDLT) using the recently introduced through-the-scope magnet.

PATIENTS AND METHODS

The MCA technique was used in patients with disconnected bile duct who could not be treated with either percutaneous or endoscopic procedures. All patients already had a percutaneous external biliary drainage catheter before the procedure. The magnet was placed percutaneously into the proximal side of the obstruction by pushing a 5-Fr catheter over a guidewire. Concurrently, endoscopic retrograde cholangiopancreatography (ERCP) including endoscopic papillary sphincterotomy was performed. The sister magnet was then carefully advanced to the opposite side of the obstruction with a 5-Fr catheter over a guidewire. After the confirmation of biliary recanalization, a guidewire was passed through the stricture and a percutaneous dilation of the stricture was performed with a balloon-tipped catheter. Endoscopic balloon dilation of the stricture, insertion of two plastic stents and the removal of the internal drainage catheter were performed during the first ERCP session. Stent exchange and multiple side-by-side stent placements were planned at regular intervals (3 monthly) for all patients.

RESULTS

A total of six LDLT patients with disconnected bile duct (aged 37 - 68, four men) underwent the MCA technique between September 2014 and July 2015. Biliary recanalization was achieved 13 - 42 days after the magnet placement procedure. The success rate of the procedure was 100 %.

CONCLUSIONS

The MCA technique using a small magnet (diameter 2.4 mm) is effective and useful in LDLT patients with disconnected bile duct.

Herniation of the liver: an extremely rare entity

We hereby present the case of a 75 years old female who was complaining of right upper quadrant abdominal pain. She had a history of cystectomy, cholecystectomy and choledochotomy operations for liver hydatid cyst 5 years ago. In addition, multiple endoscopic retrograde cholangiopancreatography sessions had been performed for recurrent biliary duct stones in the last 4 years. Radiological investigations revealed the presence of cirrhosis and the herniation of the left liver lobe through the abdominal incisional hernia defect. Secondary sclerosing cholangitis as a result of the previous operations was suggested to be the probable etiology for cirrhosis. The cirrhotic patient with an advanced age was found to be high risk for surgery. In addition, her symptoms were minimal. Thus, she was managed conservatively. Herniation of the liver is very rare. It is quite difficult to speculate any predisposing risk factors for liver herniation because of the rarity of this condition.

The ultrasonographic evaluation of hemodynamic changes in patients with diabetic polyneuropathy after tarsal tunnel decompression

BACKGROUND

Nerve decompression procedures have shown to have promising roles in patients with diabetic polyneuropathy. It is known that not only nerves but also arteries pass through the same compressed anatomical tunnels. The aim of the study is to reveal whether the surgical decompression procedures have a positive effect on hemodynamic and morphological parameters of the arterial structures passing through these anatomic tunnels.

METHODS

Twenty-seven patients who underwent posterior and anterior tarsal tunnel release procedures were retrospectively scanned for preoperative and 3 months postoperative arterial Doppler ultrasound imaging. The preoperative and third month postoperative measurements were compared for flow pattern of artery, flow lumen diameter, pulsatility index (PI), resistance index (RI), and flow volumes by evaluating the hemodynamic and morphological parameters of dorsalis pedis (DPA) and tibialis posterior arteries (TPA).

RESULTS

For TPA, mean PI values were 5.76 ± 2.78 preoperatively, 7.17 ± 3.08 postoperatively. Mean RI values were 0.94 ± 0.04 preoperatively and 0.89 ± 0.05 postoperatively. For DPA, mean PI values were 5.06 ± 2.14 preoperatively and 6.35 ± 2.31 postoperatively. Mean RI values were 0.93 ± 0.05 preoperatively and 0.86 ± 0.06 postoperatively. When the results are analyzed for both of the arteries, PI values were significantly increased; RI values were significantly decreased when the preoperative measurements were compared with the postoperative measurements (P < 0.05).

CONCLUSION

According to these results, it can be suggested that the nerve release procedures have a positive effect on the hemodynamic and morphological parameters of the arteries as they pass through the anatomical tunnels as well as its positive effects on the neurological functions of the entrapped nerves.

Genetic polymorphisms of ADH1B, ADH1C and ALDH2 in Turkish alcoholics: lack of association with alcoholism and alcoholic cirrhosis

No data exists regarding the alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) gene polymorphisms in Turkish alcoholic cirrhotics. We studied the polymorphisms of ADH1B, ADH1C and ALDH2 genes in alcoholic cirrhotics and compared the results with non-cirrhotic alcoholics and healthy volunteers. Overall, 237 subjects were included for the study: 156 alcoholic patients (78 cirrhotics, 78 non-cirrhotic alcoholics) and 81 healthy volunteers. Three different single-nucleotide-polymorphism genotyping methods were used. ADH1C genotyping was performed using a polymerase chain reaction-restriction fragment length polymorphism method. The identified ADH1C genotypes were named according to the presence or absence of the enzyme restriction sites. ADH1B (Arg47Hys) genotyping was performed using the allele specific primer extension method, and ALDH2 (Glu487Lys) genotyping was performed by a multiplex polymerase chain reaction using two allele-specific primer pairs. For ADH1B, the frequency of allele *1 in the cirrhotics, non-cirrhotic alcoholics and healthy volunteers was 97.4%, 94.9% and 99.4%, respectively. For ADH1C, the frequency of allele *1 in the cirrhotics, non-cirrhotic alcoholics and healthy volunteers was 47%, 36.3% and 45%, respectively. There was no statistical difference between the groups for ADH1B and ADH1C (p&gt;0.05). All alcoholic and non-alcoholic subjects (100%) had the allele *1 for ALDH2. The obtained results for ADH1B, ADH1C, and ALDH gene polymorphisms in the present study are similar to the results of Caucasian studies. ADH1B and ADH1C genetic variations are not related to the development of alcoholism or susceptibility to alcoholic cirrhosis. ALDH2 gene has no genetic variation in the Turkish population.

Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome

PURPOSE

This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes.

METHODS

The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens.

RESULTS

There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05).

CONCLUSION

Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.

Seroprevalence of hepatitis A,B, and C viruses in Turkish alcoholic cirrhotics and the impact of hepatitis B on clinical profile

INTRODUCTION

The aims of this study were to detect the seroprevalence of hepatitis A, B, and C viruses in Turkish alcoholic cirrhotics, and to evaluate the impact of hepatitis B infection on clinical profile at first admittance.

METHODOLOGY

Serological markers for hepatitis A, B, and C viruses in 300 alcoholic cirrhotics diagnosed between January 1994 and December 2012 were retrospectively reviewed. Among them, 148 eligible patients were divided into group 1 (HBsAg positive, n = 43) and group 2 (HBsAg and anti-HBc negative, n = 105). Clinical characteristics at first admittance of groups 1 and 2 were compared.

RESULTS

The seroprevalence of anti-HAV total, HBsAg, and anti-HCV was found to be 91.5%, 16.3%, and 8.2%, respectively. The prevalence of hepatocellular carcinoma was higher in the HbsAg-positive group compared to HbsAg- and anti-HBc-negative group (16.3% vs. 2.9%, p = 0.007). Other clinical features were similar in the two groups.

CONCLUSIONS

Alcoholic cirrhotics have higher frequencies of HBsAg and anti-HCV than the general population. These patients should be investigated for coexistent HBV and HCV infections, and HBV vaccination should not be neglected. Alcoholic cirrhotic patients with concomitant HBV infection should be closely screened for hepatocellular carcinoma.

Management of pulse oximeter probe-induced finger injuries in children: report of two consecutive cases and review of the literature

Pulse oximetry is a standard noninvasive procedure for monitoring arterial oxygen saturation. Finger injuries related to pulse oximeter use have been reported as chemical or thermal burns, sun-tanning, pressure erosion, sensory loss, and gangrene. The mechanisms of these complications have not been definitively explained; but pressure ischemia, prolonged use, overheating of the probe, inappropriate use of the probe, and short circuiting are considered to be the main factors. We describe 2 cases of pulse oximeter probe-induced finger injuries, propose the possible mechanisms and factors related to the injury, and discuss the management.

[Posttraumatic primary cutaneous aspergillosis with Candida guilliermondii infection in a healthy host]

Opportunistic fungal infections are usually seen in immunocompromised patients. While Candida is the most prevalent agent in such infections, Aspergillus is at the second order. Primary cutaneous aspergillosis is most common in immunocompromised patients but can rarely be seen in healthy hosts as well. We report a case of posttraumatic primary cutaneous aspergillosis and Candida guilliermondii coinfection in a 70-years-old healthy man. The patient had an ulcerous lesion which developed in the site of a trauma on the middle finger of the right hand. Histopathological examination of the biopsy specimens revealed septate hyphae with dichotomous branching small circular blastospores. The cultures of the biopsy specimen yielded yellow-green colored, granular mold colonies and creamy white yeast colonies. Microscopic examination of the lactophenol cotton blue stained mold colonies indicated long conidiophores with vesicles surrounded by uniseriate phialides, compatible with Aspergillus flavus. Yeast colonies were identified as Candida guilliermondii by ID32C (BioMerieux, France) and by their microscopical morphology detected in corn meal-Tween 80 agar incubated at 25°C for 72 hours. The patient was treated properly with surgical debridement and itraconazole therapy. Since the immune system is compressed as a consequence of aging, cutaneous opportunistic fungal infections should be considered in the differential diagnosis of posttraumatic necrotic ulcers and black eschar in aged patients.