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Akarsu M, Dolu S, Harputluoglu M, Yilmaz S, Akyildiz M, Gencdal G, Polat KY, Dincer D, Adanir H, Turan I, Gunsar F, Karasu Z, Gokcan H, Karademir S, Kabacam G, Kayhan MA, Kiyici M, Gulsen MT, Balaban Y, Dogrul AB, Senkaya A, Ellik ZM, Eren F, Idilman R. Changing trends in the etiology of liver transplantation in Turkiye: A multicenter study. Hepatol Forum 2024; 5:3-6. [PMID: 38283275 PMCID: PMC10809344 DOI: 10.14744/hf.2023.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024]
Abstract
Background and Aim This study aimed to identify the indications for liver transplantation (LT) based on underlying etiology and to characterize the patients who underwent LT. Materials and Methods We conducted a multicenter cross-sectional observational study across 11 tertiary centers in Turkiye from 2010 to 2020. The study included 5,080 adult patients. Results The mean age of patients was 50.3±15.2 years, with a predominance of female patients (70%). Chronic viral hepatitis (46%) was the leading etiological factor, with Hepatitis B virus infection at 35%, followed by cryptogenic cirrhosis (24%), Hepatitis C virus infection (8%), and alcohol-related liver disease (ALD) (6%). Post-2015, there was a significant increase in both the number of liver transplants and the proportion of living donor liver transplants (p<0.001). A comparative analysis of patient characteristics before and after 2015 showed a significant decline in viral hepatitis-related LT (p<0.001), whereas fatty liver disease-related LT significantly increased (p<0.001). Conclusion Chronic viral hepatitis continues to be the primary indication for LT in Turkiye. However, the proportions of non-alcoholic fatty liver disease (NAFLD) and ALD-related LT have seen an upward trend over the years.
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Affiliation(s)
- Mesut Akarsu
- Department of Gastroenterology, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Suleyman Dolu
- Department of Gastroenterology, Dokuz Eylul University School of Medicine, Izmir, Turkiye
| | - Murat Harputluoglu
- Liver Transplantation Institute, Inonu University School of Medicine, Malatya, Turkiye
| | - Sezai Yilmaz
- Liver Transplantation Institute, Inonu University School of Medicine, Malatya, Turkiye
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkiye
| | - Genco Gencdal
- Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkiye
| | - Kamil Yalcin Polat
- Liver Transplant Center, Memorial Atasehir/Bahcelievler Hospitals, Istanbul, Turkiye
| | - Dinc Dincer
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkiye
| | - Haydar Adanir
- Department of Gastroenterology, Akdeniz University School of Medicine, Antalya, Turkiye
| | - Ilker Turan
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | - Fulya Gunsar
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | - Zeki Karasu
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | - Hale Gokcan
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkiye
| | - Sedat Karademir
- Department of Gastroenterology, Guven Hospital, Ankara, Turkiye
| | - Gokhan Kabacam
- Department of Gastroenterology, Guven Hospital, Ankara, Turkiye
| | - Meral Akdogan Kayhan
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkiye
| | - Murat Kiyici
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkiye
| | - Murat Taner Gulsen
- Department of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkiye
| | - Yasemin Balaban
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkiye
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Hacettepe University, School of Medicine, Ankara, Turkiye
| | - Ali Senkaya
- Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkiye
| | | | - Fatih Eren
- Department of Gastroenterology, Uludag University School of Medicine, Bursa, Turkiye
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkiye
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Barutcu S, Yildirim AE, Sahin A, Gulsen MT. Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients with Culture Negative Neutrocytic Ascites. Sisli Etfal Hastan Tip Bul 2022; 56:77-83. [PMID: 35515960 PMCID: PMC9040302 DOI: 10.14744/semb.2021.58219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/28/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the most ideal inflammatory markers for treatment response and to determine a cutoff value that could predict response to treatment for culture negative neutrocytic ascite (CNNA) patients. METHODS This is a retrospective cross-sectional case-controlled study. Patients with CNNA were evaluated by taking ascites fluid sampling at the beginning and on the 5th day of treatment. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio were calculated. RESULTS Of the 123 cases with cirrhotic ascites disease, 59 were CCNA and 64 were the control group without ascite-fluid infection. There were statistically significant differences for blood monocyte count, NLR (p<0.01), LMR, and C-reactive protein (CRP) (p<0.001) between two groups. Patients in the CNNA group were compared before and after treatment among themselves for the treatment response. There was statistically significant difference in mean platelet volume, monocyte, LMR, and CRP (p<0.05) between two groups. After receiver operator characteristics curve analysis, the best cutoff value for monocyte was <0.64 × 103/μL (sensitivity 49.2%, specificity 74.6%, positive predictive value [PPV] 65.9%, and negative predictive value [NPV] 59.5%) (p<0.01), for LMR was ≥1.7 (sensitivity 76.3%, specificity 78%, PPV 77.6%, and NPV 76.7%), and for CRP was ≤18 mg/L (sensitivity 91.5% specificity 57.6%, PPV 68.4%, and NPV 87.2%) (p<0.001). When LMR and CRP were used together, sensitivity (86.5%), specificity (83.1%), PPV (83.6%), and NPV (86%) were found to be statistically significantly higher (p<0.001). CONCLUSION Our results showed that in cirrhotic patients with CNNA, combined LMR + CRP can be used as a novel, low cost and non-invasive test to predict treatment response.
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Affiliation(s)
- Sezgin Barutcu
- Division of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Abdullah Emre Yildirim
- Division of Gastroenterology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Ahmet Sahin
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Turkey, Mehmet Akif Inan Research and Training Hospital, Şanlıurfa, Turkey
| | - Murat Taner Gulsen
- Department of Infectious Disease and Clinical Microbiology, University of Health Sciences Turkey, Mehmet Akif Inan Research and Training Hospital, Şanlıurfa, Turkey
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Abstract
Extrahepatic cholangiocarcinoma (ECC) is an aggressive malignancy causing a lot of fatalities and comorbidities. Endoscopic biliary stenting (EBS) is mostly needed for ECC. In this study, we aimed to investigate the prognostic factors for the overall survival (OS) and the factors predicting the patients eligible for chemotherapy after EBS in ECC.We retrospectively screened 153 advanced ECC patients who underwent EBS for jaundice to make the patients eligible for chemotherapy. Patient's clinical and laboratory parameters were recorded. OS was estimated by the Kaplan-Meier method. All parameters were assessed by binary logistic regression analysis to predict which patients are eligible for chemotherapy.The median OS of all patients was 12.0 months (10.1-13.8). The median OS of the patients treated with chemotherapy was 13.0 months (12.0-14.0), while it was 4.0 months (2.3-5.7) for patients unable for chemotherapy after EBS. Albumin, aspartate aminotransferase (ALT) and carbohydrate antigen 19-9 (CA 19-9) values were independent prognostic factors for OS. Higher albumin and lower prothrombin time (PT) levels were independent parameters to predict the patients eligible for chemotherapy after EBS.Being suitable for chemotherapy was the main determinant for prolonged survival and albumin and PT levels were independent predictors for chemotherapy eligibility after EBS. Albumin, ALT, and CA 19-9 values were independent prognostic factors for OS in ECC.
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Affiliation(s)
- Gokmen Aktas
- Department of Medical Oncology, Kahramanmaras Sütçü İmam University School of Medicine, Kahramanmaraş
| | - Tulay Kus
- Adiyaman University, Training and Research Hospital, Clinics of Medical Oncology Adiyaman
| | | | - Taylan Metin
- Department of Internal Medicine, Gaziantep University School of Medicine, Gaziantep
| | | | - Huseyin Abali
- Department of Medical Oncology, Acibadem University School of Medicine, Istanbul, Turkey
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Balkan A, Bati O, Metin T, Gulsen MT. Efficacy of regimens containing pegylated interferon and ribavirin in the treatment of chronic hepatitis C: A retrospective overview. Eur J Ther 2018. [DOI: 10.5152/eurjther.2017.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Balkan A, Kimyon S, Mete A, Gulsen MT. A rare manifestation of Crohn’s disease in an adolescent: Optic neuritis. Eur J Ther 2018. [DOI: 10.5152/eurjther.2017.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Balkan A, Gulsen MT, Balkan Y, Kaya Cali S. Relationship between the frequency of hepatitis B virus infections and levels of serum adipokines in patients with hepatosteatosis and insulin resistance. Eur J Ther 2017. [DOI: 10.5152/eurjther.2017.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Balkan A, Kirik MP, Gundes I, Haydaroglu Sahin H, Budeyri S, Balkan Y, Gulsen MT, Pehlivan M. The frequency of hepatitis B virus reactivation in patients with bone marrow transplantation. Eur J Ther 2017. [DOI: 10.5152/eurjther.2017.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yıldırım AE, Öztürk ZA, Konduk BT, Balkan A, Edizer B, Gulsen MT, Savas MC, Kadayıfcı A. The safety and efficacy of ERCP in octogenarians: a comparison of two geriatric age cohorts. Acta Gastroenterol Belg 2017; 80:263-270. [PMID: 29560692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS The application of endoscopic retrograde cholangiopancreatography (ERCP) in the octogenarian population is limited. The aim of the study was to compare the clinical characteristics and outcomes of ERCP in octogenarian patients with non-octogenarian elderly patients. MATERIALS METHODS A total of 1044 patients who underwent ERCP for the first time and are over the age of 65 were enrolled in this study. Data regarding demographic characteristics, medical history of patients, indications, technical success rate, final clinical diagnosis and complications were analyzed. 284 patients and 760 patients composed the octogenarian and non-octogenarian group, respectively. RESULTS The mean ages in octogenarian and non-octogenarian groups were 83.99±3.85 and 71.50±4.27 years of age respectively. Both groups had similar values with regards to chronic concomitant diseases (96.6% vs. 96.5%). The most common indication of ERCP in the two groups was common bile duct stones. There was no significant difference in technical success and failure of cannulation in procedures of either group (p > 0,05). The duration of overall ERCP procedure was shorter in length in the non-octogenarian group in comparison to the octogenarian group (p = 0.004). The overall complication rate was similar in both groups (p > 0.177). The most common complication in either group was post-ERCP pancreatitis. CONCLUSIONS ERCP is an effective and safe procedure in both octogenarian and non-octogenarian patients with naive papilla when performed by experienced endoscopists.
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Affiliation(s)
- A E Yıldırım
- Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Turkey
| | - Z A Öztürk
- Division of Geriatrics, Faculty of Medicine, University of Gaziantep, Turkey
| | - B T Konduk
- Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Turkey
| | - A Balkan
- Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Turkey
| | - B Edizer
- Division of Internal Medicine, Faculty of Medicine, University of Gaziantep, Turkey
| | - M T Gulsen
- Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Turkey
| | - M C Savas
- Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Turkey
| | - A Kadayıfcı
- Division of Gastroenterology, Faculty of Medicine, University of Gaziantep, Turkey
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Koklu S, Gulsen MT, Tuna Y, Koklu H, Yuksel O, Demir M, Guner R, Dogan Z, Kucukazman M, Poyrazoglu OK, Biyik M, Ozturk NA, Aydogan T, Coban S, Kocaman O, Sapmaz F, Gokturk SH, Karaca C, Demirezer A, Tanoglu A, Yildirim B, Altinbas A, Atak BM, Cosar AM, Alkan E. Differences in nephrotoxicity risk and renal effects among anti-viral therapies against hepatitis B. Aliment Pharmacol Ther 2015; 41:310-9. [PMID: 25982037 DOI: 10.1111/apt.13036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 09/03/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Results are conflicting with respect to the renal effects of anti-viral agents used for hepatitis B virus infection. AIM To compare short and long-term renal effects in real-life settings and to determine risk factors for renal impairment during treatment. METHODS 2221 treatment-naïve patients were enrolled. Among these, 895 (302 lamivudine, 27 telbivudine, 282 entecavir, 273 tenofovir and 11 adefovir initiated patients) had 'repeated measures' of creatinine (baseline, 1st, 6th, 12th and 24th month of treatment). Telbivudine and adefovir groups were excluded from further analysis because of the low number of patients. We calculated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula at each time point. Hypophosphataemia was also recorded. Risk factors for renal impairment were analysed. RESULTS Tenofovir caused a decline in GFR at each time point when compared to baseline levels. However, lamivudine and entecavir did not change GFR. GFR-shifting from ≥90 to 60-89 mL/min/1.73 m(2) was comparable among groups. The proportion of patients whose baseline creatinine increased more than 25% was comparable among all anti-virals. GFR showed a decline in patients who switched from entecavir to tenofovir. One patient with compensated cirrhosis needed to change from tenofovir because of renal safety. Seven and three patients developed transient hypophosphataemia in the tenofovir and lamivudine groups, respectively. CONCLUSIONS Although tenofovir caused a decline in GFR, differences between the anti-viral agents do not appear to be so impressive. In patients with and without renal risk factors at baseline, there is no impact of anti-virals, including tenofovir.
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Affiliation(s)
- S Koklu
- Department of Gastroenterology, Hacettepe University School of Medicine, Ankara, Turkey
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10
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Cikman O, Taysi S, Gulsen MT, Demir E, Akan M, Diril H, Kiraz HA, Karaayvaz M, Tarakcioglu M. The Radio-protective effects of Caffeic Acid Phenethyl Ester and Thymoquinone in rats exposed to total head irradiation. Wien Klin Wochenschr 2014; 127:103-8. [DOI: 10.1007/s00508-014-0635-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
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11
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Koklu S, Gulsen MT, Tuna Y, Koklu H, Yuksel O, Yilmaz B, Karaca C, Ataseven H, Guner R, Kucukazman M, Kockar C, Demir M, Poyrazoglu OK, Ibis M, Purnak T, Etgul S, Alkan E, Coban S, Gokturk S, Biyik M, Baykal O, Basar O, Koklu N, Tatar G, Simsek H. Lamivudine treatment failure risks in chronic hepatitis B patients with low viral load. Digestion 2014; 88:266-71. [PMID: 24356645 DOI: 10.1159/000356312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/30/2013] [Indexed: 02/04/2023]
Abstract
AIM To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). MATERIAL AND METHODS In this multicenter study, 548 antiviral naïve noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA <10 9 copies/ml and for HBeAg–patients HBV DNA <10 7 copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. RESULTS Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with <100,000 copies/ml and ≥ 100,000 copies/ ml had 54.8 and 67.3% LTF rates at the end of the 5th year, respectively. Logistic regression analysis of risk factors showed HBeAg+, hepatic activity index, HBV DNA, virological response at 6 months and duration of follow-up were independent predictors for LTF (p values were 0.001, 0.008, 0.003, 0.020 and 0.003, respectively). CONCLUSION Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors.
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Zengin S, Al B, Genç S, Yarbil P, Yilmaz DA, Gulsen MT. A rare case of portal vein gas: accidental hydrogen peroxide ingestion. BMJ Case Rep 2012; 2012:bcr.01.2012.5602. [PMID: 22669852 DOI: 10.1136/bcr.01.2012.5602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hydrogen peroxide (H(2)O(2)) is a colourless and odourless liquid with oxidant characteristics used for various purposes. Whereas in lower concentrations (3%), H(2)O(2) is used as a disinfectant in home cleaning products and wound care, in higher concentrations (35%) it is used in textile and paper industry as a bleaching agent and is diluted for use in lightening hair dyes. Like other caustic substances, direct injuries may develop if H(2)O(2) is swallowed and systemic air embolisms may occur due to the resultant gaseous oxygen. This study discusses a patient who was detected with the presence of gas in the portal venous system due to H(2)O(2) intoxication and was treated conservatively.
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Affiliation(s)
- Suat Zengin
- Emergency Department of Medicine, Faculty of Gaziantep University, Gaziantep, Turkey.
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13
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Gulsen MT, Beyazit Y, Guclu M, Koklu S. Testing for hepatitis B and C virus infection before upper gastrointestinal endoscopy: justification for dedicated endoscope and room for hepatitis patients. Hepatogastroenterology 2010; 57:797-800. [PMID: 21033232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIMS Endoscopic interventions have become a significant tool in the diagnosis and treatment of gastrointestinal disorders. In order to avoid transmission of associated diseases, cleaning and disinfection/sterilization procedures of endoscopes and accessories are crucial. Hepatitis B virus and Hepatitis C virus infections are among the most common viral infections globally and maintain their position as a serious public health problem. METHODOLOGY One thousand patients visiting our gastroenterology department were diagnosed and, except for cirrhosis, were enrolled in this study. For patients with HBsAg and Anti-HCV positive, Aspartate Aminotransferase, Alanine Aminotransferase, hemogram and prothrombin time were examined and ultrasonography was performed. RESULTS Five hundred and seventy three patients (57.3%) were female and 427 patients (42.7%) were male. Among 1000 patients in total, 39 patients were detected to have hepatitis (3.9%). Of these patients, 28 (2.8%) had HBsAg (+), 10 (1%) had Anti-HCV (+), 1 (0.1%) had both HBsAg (+) and Anti-HCV (+). CONCLUSIONS It would be beneficial to include a determination of hepatitis serology of patients prior to endoscopy in daily practice. In addition, like dialysis machines, there is a need for further studies evaluating the cost effectiveness of using separate endoscopy devices allocated to groups of patients with HBV, HCV or to those who do not carry hepatitis.
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Affiliation(s)
- Murat Taner Gulsen
- Department of Gastroenterology, Gaziantep University School of Medicine, Gaziantep, Turkey
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14
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Buyukberber M, Sevinc A, Cagliyan CE, Gulsen MT, Sari I, Camci C. Non-Hodgkin lymphoma with high adenosine deaminase levels mimicking peritoneal tuberculosis: an unusual presentation. Leuk Lymphoma 2006; 47:565-8. [PMID: 16396783 DOI: 10.1080/10428190500395472] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Abdominal tuberculosis is still a medical problem in developing countries. The clinical presentation of tuberculous (TB) peritonitis may be similar to that of peritoneal carcinomatosis. Therefore, its diagnosis is rather difficult only with laboratory investigations. Ascitic fluid adenosine deaminase (ADA) activity has been proposed as a useful diagnostic test in tuberculous peritonitis, as many studies reported high ADA levels in TB peritonitis. On the other hand, ADA activity is usually lower in peritoneal carcinomatosis and malignant ascites. This study described a patient with non-Hodgkin lymphoma with elevated (67 U L(-1)) ADA levels and clinical signs mimicking peritoneal tuberculosis. On admission, this study focused on the high value of ADA in ascites and strongly suspected TP. Although anti-tuberculous agents were initiated, his general condition did not improve. Finally, laparoscopic peritoneal biopsy was performed and non-Hodgkin lymphoma diagnosed. In the light of these findings, ADA level may not reflect TB peritonitis in the absence of histopathological examination. Therefore, non-Hodgkin lymphoma should be kept in mind in the differential diagnosis in patients with high ascitic fluid ADA levels and in non-responders to anti-tuberculosis treatment.
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Affiliation(s)
- Mehmet Buyukberber
- Department of Gastroenterology, School of Medicine, Sahinbey Medical Center, Gaziantep, TR-27310, Turkey
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Gulsen MT, Savas MC, Koruk M, Kadayifci A, Demirci F. Fascioliasis: a report of five cases presenting with common bile duct obstruction. Neth J Med 2006; 64:17-9. [PMID: 16421437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Fascioliasis is a zoonotic infection caused by Fasciola hepatica. It is rarely seen with icterus caused by obstruction of the common bile duct. We report five patients with obstructive jaundice due to Fasciola hepatica, who were diagnosed and managed with endoscopic retrograde cholangiopancreatography (ERCP). All cases were admitted to hospital with complaints of icterus and pain in the right upper quadrant of the abdomen; their biochemical values were interpreted as obstructive jaundice. Ultrasound and computer tomography (CT) revealed biliary dilatation in the common bile duct, but did not help to clarify the differential diagnosis. ERCP showed the presence of Fasciola hepatica in the common bile duct. After removing the flukes, the symptoms disappeared and the biochemical values returned to normal. Biliary fascioliasis should be considered in the differential diagnosis of obstructive jaundice. This report confirms the diagnostic and therapeutic role of ERCP in patients with obstructive jaundice caused by biliary fascioliasis.
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Affiliation(s)
- M T Gulsen
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
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16
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Abstract
Although there are many cases of oesophagitis related to pill in medical literature, there are only a few reports concerning oesophagitis related to oral contraceptives, and none about cyproterone acetate and ethinylestradiol combination (Diane-35). In this report, we describe a female patient who suffered from odynophagia and retrosternal pain after taking Diane-35 for hirsutism. The endoscopic examination revealed two well-demarcated circumferential ulcers of 1 cm diameter surrounded by relatively normal mucosa in mid-oesophagus. The patient had gone to bed immediately after taking the pill. Oral intake was stopped, and intravenous fluids and omeprazole were administered as part of treatment. The patient benefited from this approach very quickly and was discharged from hospital in 5 days. The oesophagus was completely normal in control endoscopy after 2 months. Diane-35 should be added to the list of drugs causing pill oesophagitis, and physicians should inform the patients that the pills should be taken with enough water and they should not lie down right after ingesting the pills.
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Affiliation(s)
- M T Gulsen
- Division of Gastroenterology, Department of Internal Medicine, University of Gaziantep, Gaziantep, Turkey.
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17
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Abstract
Pill-induced esophagitis is a complication seen in patients who use certain medications such as tetracycline and non-steroidal anti-inflammatory drugs. In this short report, we described five cases of doxycycline-induced esophagitis with endoscopic images. All of the patients were young or middle-aged women. Dysphagia or odynophagia with retrosternal pain were the main presenting symptoms in all cases. The observed injuries were at the middle third of esophagus with a normal surrounding mucosa. All patients had a history of swallowing the capsule with a small amount of water or in a recumbent position. Two patients with dysphagia were managed by intravenous fluid support and parenteral acid suppression. The symptoms were improved in 2-7 days after the ceasing of the drug and control endoscopies were completely normal in all cases after 3-4 weeks of admission. The drug-induced esophagitis is not rare with certain drugs and should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough liquid and in the upright position.
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Affiliation(s)
- A Kadayifci
- Department of Gastroenterology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
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