Primary Malignant Melanoma of the Esophagus

Primary malignant melanoma of the esophagus (PMME) comprises only 0.1-0.2% of all malignant esophageal tumors. PMME tumors are highly aggressive and metastasize early via hematogenic and lymphatic pathways. Treatment outcome is poor because the cancer has often advanced at the time of diagnosis. Inoperability, unsuccessful treatment with radiotherapy and chemotherapy in advanced tumors and metastases have contributed to its poor prognosis. Here, we present the endoscopic features, endoscopic ultrasonography findings and management of a PMME case

PERNICIOUS ANEMIA ASSOCIATED WITH CRYPTOGENIC CIRRHOSIS

Cytopenia may occur in cirrhosis due to hypersplenism. However severe cytopenia is rare in cirrhosis. In this situation, together with diseases of bone marrow infiltration pernicious anemia with pancytopenia should also be considered in differential diagnosis. In literature, association of pernicious anemia and chronic liver disease was reported as a case presentation. In this paper a case with severe pancytopenia which has been proved as cryptogenic liver cirrhosis is presented

Treatment of hepatic hydrothorax with terlipressin in a cirrhotic patient

Hepatic hydrothorax is a complication of cirrhosis that is uncommon and difficult to treat. Diuretic therapy, thoracentesis, transjugular intrahepatic portosystemic shunt and liver transplantation are the main therapeutic options. Here, we report on a 47-year-old man with decompensated liver cirrhosis related to hepatitis B and D virus infections and who had complications of hepatic hydrothorax and hepatorenal syndrome. In this case, the hepatic hydrothorax, which was refractory to thoracic tube drainage and octreotide treatment, could be controlled with 5 days of terlipressin therapy associated with albumin. Terlipressin administration resulted in both improvement in renal function and successful resolution of hepatic hydrothorax. Splanchnic vasoconstrictor agents that reduce splanchnic blood flow, increase both central volume and effective renal blood flow. Thus they improve renal function. In our case, terlipressin, known to be beneficial in hepatorenal syndrome, was also effective in the treatment of hepatic hydrothorax probably by similar mechanisms. This is the first case in the literature

The quality of life in hemodialysis patients with chronic hepatitis C virus infection

Background/aims: We aimed to determine the quality of life in treated and untreated hemodialysis patients with chronic hepatitis C virus infection. Methods: Ninety-five chronic renal failure patients with positive antiHCV/HCV-RNA were enrolled in this prospective study. All patients were questioned using the Short Form-36 (SF-36) health survey to evaluate life quality after the treatment. Fifty-five (ALT>1.5 ULN) were treated with interferon-alpha-2b [3MU/tiw, sc, 6 (30 patients) and 12 (25 patients) months], and 40 (11 renal transplanted) were untreated. Fifteen patients had renal transplantation in a mean of 24.6 +/- 12.5 months after interferon-alpha treatment. Results: The mean age of the patients was 37 +/- 10 years, and 58 were male. The mean durations of hemodialysis and renal transplantation were 6.4 +/- 3.8 and 5.9 +/- 4.6 years, respectively. Interferon treatment had a negative effect on general health perception, physical activity and anxiety about the disease (p0.05). General health and physical activity were better in transplanted patients than patients undergoing hemodialysis (p<0.05). Conclusions: General health perception slightly increased positively in interferon responder patients. However, general health perception and physical activity were affected negatively by interferon treatment in the whole group analysis. Renal-transplanted patients have a better life quality compared with those on hemodialysis

The position of transarterial chemoembolization with drug-eluting beads and yttrium-90 transarterial radioembolization in patients with hepatocellular carcinoma: Consensus statements from a Delphi-method expert panel in Turkey

PURPOSE Clinical studies conducted in different geographic regions using different methods to compare transarterial chemoembolization (TACE) and transarterial radioembolization ( TARE) have demonstrated discordant results. Meta-analyses in this field indicate comparable overall survival (OS) with TACE and TARE, while reporting a longer time to progression and a higher downstaging effect with TARE treatment. In terms of isolated procedure costs, treatment with TARE is 2 to 3 times more, and in some countries even more, expensive than TACE. However, relevant literature indicates that TARE is more advantageous compared to TACE regarding the need for repeat procedures, costs of complication management, total hospital stay and quality of life. Heterogeneity of hepatocellular carcinoma (HCC) patients as well as the shortcomings of clinical classifications, randomized clinical trials and cost-effectiveness studies make it difficult to choose between treatment alternatives in this field. As in other countries, these challenges lead to differences in treatment choice across different centers in Turkey. METHODS The present expert panel used two round modified Delphi method to investigate the resources and clinical parameters referenced while selecting patients for drug-eluting beads (DEB)-TACE and TARE treatment modalities in Turkish clinical practice. The cost-effectiveness parameters and comparisons of these treatments have also been evaluated at a prediction level. RESULTS The panelists stated that they most commonly use the BCLC staging system for the management of HCC patients in Turkey. However, they did not find any of the staging systems or treatment guidelines sufficient enough for their clinical practice in terms of covering the down-staging intent of treatments. Since living donor transplant preference is higher in Turkey than the rest of the Western countries, down-staging treatments are thought to be more prioritized in Turkey than that in other Western countries. The panelists reached a consensus that TARE may provide improved OS and reduce the number of repeat procedures compared to DEB-TACE in intermediate-stage patients with a single tumor spanning a diameter above 5 cm who experience recurrence after previous treatment with TACE and most TACE-naive patient groups in intermediate stage. CONCLUSION Based on the consensus on OS and the number of procedures, the panelists assumed that TARE would be more cost-effective than DEB-TACE in most groups of TACE-naive patients in intermediate stage and in those with a single tumor spanning a diameter above 5 cm. It was also stated that the predicted cost-effectiveness advantage of TARE could be more pronounced in patients with a tumor diameter greater than 7 cm.This study is funded by Boston Scientific.Boston Scientifi