Low molecular weight heparin treatment of acute moderate and severe pancreatitis: A randomized, controlled, open-label study

Conclusion: Low molecular weight heparin treatment is safe and provides better prognosis in MSAP

Fatty liver disease might increase the risk of abdominal operation in patients with fatty liver and the prevalence of cancer in first-degree relatives

63rd Annual Meeting of the American-Association-for-the-Study-of-Liver-Disease (AASLD) -- NOV 09-13, 2012 -- Boston, MAWOS: 000353553700026PubMed ID: 25910292Background/Aims: We investigated the risk of abdominal operation in patients with fatty liver and the risk of any cancer in first-degree relatives of patients with fatty liver. Materials and Methods: We evaluated 105 patients with nonalcoholic fatty liver disease (NAFLD), 121 patients with biopsy-proven hepatitis C (61 patients with fatty liver and 60 patients without fatty liver), 50 patients with inflammatory bowel disease (IBD), and 109 patients with dyspepsia. Results: There was no difference in sex, mean age, and marital status among the groups except that patients with IBD were younger than the others (p<0.001). The frequency of cancer among family members was 18% in IBD, 9% in dyspepsia, 28% in hepatitis C with steatosis, 21.5% in hepatitis C without steatosis, and 27% in NAFLD (p=0.006). Then, we divided the study group into two groups as follows: group 1: (IBD + dyspepsia + hepatitis C without steatosis) and group 2: (hepatitis C with steatosis + NAFLD). We found that the frequency of cancer was 16% in group 1 versus 24.4 % in group 2 (p=0.037). We also investigated the risk of abdominal operation in patients with fatty liver. The results were as follows: 33% in group without fatty liver versus 43% in group with fatty liver (p=0.043). Conclusion: Understanding the underlying causes of fatty liver forms might decrease the cancer frequency in the population and number of operations in patients with fatty liver.American Association for the Study of Liver Disease

Kemik ve Lenf Nodu Tutulumu ile Birlikte Yaygın Metastazı Olan Gastrointestinal Stromal Tümör

Gastrointestinal stromal tümörler (GİST), gastrointestinal traktusun en sık görülen mezenkimal tümörleridir. GİST’lerin; mide (%60), ince barsak (%30), kolon ve rektum (%5-10), daha azı (%1) ise özofagus, omentum, mezenter veya retroperitonal bölgelerden kaynaklanmaktadır. Tanı konulduğunda vakaların yaklaşık yarısı metastaz yapmış durumdadır ve en sık karaciğer (%50-60) ve peritona (%20-43) metastaz yaparlar. GİST’lerde kemik ve lenf nodu metastazı ise literatürde oldukça az sayıda bildirilmiştir. Sunulan olguda midede 22 cm çaplı GİST saptanmış ve cerrahi ile tamamen eksize edilmiştir. Operasyon sonrası değerlendirmede metastazı olmayan olguya, kütle boyutunun büyük oluşu (&gt;10 cm) ve artmış mitoz sayısı (&gt;5/10 hpf) nedeni ile yüksek riskli kabul edilerek imatinib tedavisi verilmiştir. İmatinib tedavisinin altıncı yılında karın ağrısı ve şişkinlik şikâyetleri ile başvuran hastada karaciğer, periton, kemik ve lenf nodlarında yaygın metastaz saptanmıştır. Bu çalışmada, tamamen çıkarılmış ve imatinib tedavisinin altıncı yılında atipik metastazlarla başvuran GİST’li olgu literatür eşliğinde gözden geçirilmişti

A Novel Round Insulated Tip Papillotome as an Alternative to the Classic Needle-Knife for Precut Sphincterotomy in Endoscopic Retrograde Cholangiopancreatography

Objective. The purpose of this study was to investigate the efficacy and safety of a new round insulated tip papillotome (r-ITP) as compared to that of the classic needle-knife sphincterotome (NKS) in difficult-to-cannulate endoscopic retrograde cholangiopancreatography (ERCP) patients. Materials and Methods. Patients with no exclusion criteria and an intact papilla referred for ERCP were invited to participate in the study. “Difficult-to-cannulate” patients, defined as failure to achieve deep biliary cannulation within five minutes from the first touch of papilla, with no more than ten attempts permitted, were randomly assigned for precut sphincterotomy using either the classic NKS or r-ITP. Results. Seventy and 69 patients were randomly assigned to the NKS and r-ITP groups, respectively. The groups were comparable regarding age, sex, indications, and associated conditions. There was no statistically significant difference in terms of successful cannulation or post-ERCP complications between the two groups. Only five patients (3.6%) developed mild to moderate post-ERCP pancreatitis and two had mild bleeding. No perforations or deaths were encountered. Conclusions. Although the round insulated tip papillotome was not shown to be superior to the classic NKS concerning efficacy and safety when used by an experienced endoscopist, it remains a simple, safe, and efficacious alternative

Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

Background: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. Materials and Methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17–92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease

Fatty liver disease might increase the risk of abdominal operation in patients with fatty liver and the prevalence of cancer in first-degree relatives (Retraction of vol 25, pg 138, 2014)

WOS: 000355104900026

Fatty liver disease might increase the risk of abdominal operation in patients with fatty liver and the prevalence of cancer in first-degree relatives (Retracted article. See vol. 26, pg. 290, 2015)

Background/Aims: We investigated the risk of abdominal operation in patients with fatty liver and the risk of any cancer in first-degree relatives of patients with fatty liver

Lichen Planus Induced by Pegylated Interferon Alfa-2a Therapy in a Patient Monitored for Delta Hepatitis

Interferons are used for treatment of chronic hepatitis B. They can induce or exacerbate some skin disorders, such as lichen planus. In this study, as we know, we presented the first case developing lichen planus while receiving interferon treatment due to delta hepatitis. A 31-year-old male patient presented to our outpatient clinic with HBsAg positivity. With his analyses, HBV DNA was negative, anti-delta total was positive, ALT was 72 U/L (upper limit 41 U/L), and platelet was 119 000/mm3. He was therefore started on subcutaneous pegylated interferon alfa-2a therapy at 180 mcg/week for delta hepatitis. At month 4 of therapy, the patient developed diffuse eroded lace-like lesions in oral mucosa, white plaques on lips, and itchy papular lesions in the hands and feet. Lichen planus was considered by the dermatology clinic and topical treatment (mometasone furoate) was given. The lesions persisted at month 5 of therapy and biopsy samples were obtained from oral mucosal lesions and interferon dose was reduced to 135 mcg/week. Biopsy demonstrated nonkeratinized stratified squamous epithelium; epithelial acanthosis, spongiosis, and apoptotic bodies were observed in the epidermis and therefore lichen planus was considered. At month 6 of therapy, lesions did not improve and even progressed and interferon treatment was therefore discontinued