In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Gallbladder malignant lymphoma: A rare case

Gallbladder cancer is extremely rare and the prognosisis poor. Malignant lymphoma of the gallbladder in all gallbladdertumors constitute only 0.1-0.2%. 61-year-old malepatient admitted to our clinic with abdominal pain and indigestioncomplaint for about 2 months. Approximately 1.5x1, 5 cm polypoid lesion was detected radiological examinationsin the gall bladder. The patient underwent laparoscopiccholecystectomy procedure. Because of the histopathologicalexamination gallbladder malign lymphoma(large B cell type) was detected. He received 8 cycles ofchemotherapy as adjuvant treatment. 24-month follow-upof recurrence or metastasis was not detected.Key words: Laparoscopy, lymphoma, gallbladder

Invasive papillary carcinoma of the male breast

Meme kanseri erkeklerde oldukça nadir görülür. Erkekte, kadın meme kanserlerinin tüm histolojik tipleri görülebilir. İnvaziv papiller karsinom ise nadir görülen bir meme kanseri tipidir. Memenin invaziv papiller karsinomu nedeniyle modifiye radikal mastektomi yapılan 67 yaşında bir erkek hastayı sunduk. Sağ memesinde ağrısız kitle yakınması ile kliniğimize başvurdu. Görüntüleme eşliğinde tru-cut biyopsi yapıldı. Biyopsi sonrası patolojik bulgular invaziv papiller karsinom ile uyumluydu. Modifiye radikal mastektomi işelemi uygulandı. 24 aylık takiplerinde nüks saptanmadı.Breast cancer is rarely seen in male patients. All the histological types of female breast cancer can be seen in male patients. Invasive papillary carcinoma is a rare breast cancer type. We hereby report the case of a 67-year-old male patient who underwent modified radical mastectomy because of invasive papillary carcinoma. The patient presented to our clinic with the complaint of a painless mass in his right breast. Tru-cut biopsy guided by imaging was performed. The pathological results of the biopsy were in line with invasive papillary carcinoma. We performed modified radical mastectomy on the patient. No recurrences were seen in the 24-month follow-up period

Renal hücreli karsinom ile birlikte midede gastrointestinal stromal tümör

Gastrointestinal stromal tümörler (GİST), gastrointestinal sistem (GİS)in en sık mezenkimal tümörleridir. Renal hücreli kanserler (RCC) ile birlikte bulunabilirler. İkili vakalar literatürde rapor edilmekle beraber, bunlar olgu raporları biçimindedir. Bu olgu raporunda midede GIST olan ve aynı anda RCC tespit edilen bir hasta sunulmaktadır. Tedavi kapsamında, midede kama rezeksiyonu ve parsiyel nefrektomi uygulandı. Ameliyat sonrası komplikasyonu olmayan hasta, post-op 7. günde taburcu edildi.Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the gastrointestinal system (GIS). They may co-exist with renal cell cancers (RCC). While a couple of cases have been reported in literature, these are in the form of case reports. This case report presents the case of a patient with GIST in the stomach and simultaneously detected RCC. Within the scope of the treatment, wedge resection to the stomach and partial nephrectomy were performed. The patient, who had no post-op complications, was discharged on post-op day 7. Gastrointestinal stromal tumours (GIST) are the most common mes- enchymal tumours of the gastrointestinal system (GIS). They may co-exist with renal cell cancers (RCC). While a couple of cases have been reported in literature, these are in the form of case reports. This case report presents the case of a patient with GIST in the stomach and simultaneously detected RCC. Within the scope of the treatment, wedge resection to the stomach and partial nephrectomy were performed. The patient, who had no post-op complications, was discharged on post-op day 7

Gastrointestinal stromal tumors of the small ıntestine ın emergency surgery

Amaç: Gastrointestinal stromal tümörler (GİST) gastrointestinal traktın en yaygın mezenkimal tümörleridir. En sık görülen lokalizasyonlar mide ve ince barsak dır. Bu çalışmada ince barsak lokalizasyonlu acil GİST vakalarında kliniğimizin cerrahi yaklaşımını, tümörlerin özelliklerini ve klinik prezentasyonlarını ortaya koymayı amaçladık. Gereç yöntem: Ocak 2006- Aralık 2011 yılları arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesinde acil şartlarda opere edilen 8 ince barsak GIST vakası retrospektif olarak incelendi. Bulgular: Kliniğimizde tanısı konmuş 84 GİST vakası mevcuttu. Bunlardan 21'inde ince barsak GİST'İ saptandı. Bu vakalarında 8'i acil olarak başvuran ve opere edilen hastalardı. Bu hastaların 4'ü (%50) kadın, 4'ü erkek (%50) olup, ortalama yaşları 65 idi. Tüm hastalar acil başvurmuş ve tüm olgulara acil cerrahi uygulanmıştır. Postoperatif erken dönemde 1 (%14) hastada mortalite görüldü. Ortalama 30 aylık takiplerinde rekürrens görülmedi. Sonuç: Deneyimimiz gösterdi ki GIST'lere acil cerrahi müdahale gerekebilmektedir. Tümör boyutu ile tümörün semptomatik olması arasında ilişki olabileceği düşünülmüştür. Nadiren lenf nodlarına metastaz yaptıkları ve negatif cerrahi sınır elde etmek zor olmadığından laparoskopik rezeksiyon genelde mümkündür. Uygun vakalarda laparoskopik yöntemler tercih edilmelidirAim: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The most frequent localizations are the stomach (50-60%) and the small intestine (20-30%). In this study, our aim is to present the surgical approach of our clinic to emergency GIST cases with small intestinal localization, the features of the tumors and their clinical presentations. Material and Method: The cases of 8 patients with GISTs of the small intestine, who had emergency surgery between January 2006 and December 2011 at Necmettin Erbakan University, Meram Medical School, were evaluated retrospectively. Results: There were 84 diagnosed GIST cases at our clinic. 21 of these had GIST of the small intestine. 8 out of these 21 cases had presented in emergency and had been operated on. 4 of these patients were female (50%), while 4 were male (50%) and the average age of the patients was 65 . All patients presented in emergency and emergency surgery was performed on all the cases. Mortality was seen in 1 (14%) patient during the early post-op period. No recurrences were seen during the 30 months of average follow-up. Conclusion: Our experience revealed that emergency surgical intervention might be needed for GISTs. It was considered that there might be a relationship between the tumor size and the fact that the tumor was symptomatic. Laparoscopic resection is generally possible since they are rarely metastatic to the lymph nodes and it is not difficult to obtain negative surgical borders. Laparoscopic methods should be preferred in appropriate case

İnce barsak gastrointestinal stromal tümörlerinde acil cerrahi

Amaç: Gastrointestinal stromal tümörler GİST gastrointestinal traktın en yaygın mezenkimal tümörleridir. En sık görülen lokalizasyonlar mide ve ince barsak dır. Bu çalışmada ince barsak lokalizasyonlu acil GİST vakalarında kliniğimizin cerrahi yaklaşımını, tümörlerin özelliklerini ve klinik prezentasyonlarını ortaya koymayı amaçladık. Gereç yöntem: Ocak 2006- Aralık 2011 yılları arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesinde acil şartlarda opere edilen 8 ince barsak GIST vakası retrospektif olarak incelendi. Bulgular: Kliniğimizde tanısı konmuş 84 GİST vakası mevcuttu. Bunlardan 21’inde ince barsak GİST’İ saptandı. Bu vakalarında 8’i acil olarak başvuran ve opere edilen hastalardı. Bu hastaların 4’ü %50 kadın, 4’ü erkek %50 olup, ortalama yaşları 65 idi. Tüm hastalar acil başvurmuş ve tüm olgulara acil cerrahi uygulanmıştır. Postoperatif erken dönemde 1 %14 hastada mortalite görüldü. Ortalama 30 aylık takiplerinde rekürrens görülmedi. Sonuç: Deneyimimiz gösterdi ki GIST’lere acil cerrahi müdahale gerekebilmektedir. Tümör boyutu ile tümörün semptomatik olması arasında ilişki olabileceği düşünülmüştür. Nadiren lenf nodlarına metastaz yaptıkları ve negatif cerrahi sınır elde etmek zor olmadığından laparoskopik rezeksiyon genelde mümkündür. Uygun vakalarda laparoskopik yöntemler tercih edilmelidi

Hyperbaric oxygen therapy for carbon monoxide poisoning

Carbon monoxide poisoning is a life-threatening poisoning. In this case report neurological findings developed in carbon monoxide poisoning and the importance of multidisciplinary approach are discussed. The patient, 16-year-old male, was found unconscious following a 1-hour exposure to gas water heater poisoning and brought to our hospital after being intubated at the scene of the accident. After treatment for bicarbonate deficit, hepatamine infusion was started and hyperbaric oxygen treatment was performed. The patient was connected to mechanical ventilator in our department. The treatment were performed for cerebral edema. And hyperbaric oxygen treatment continued for 12 days. The patient was disconnected from the ventilator on the 36 th day of the follow-up. Medical history and clinical examination are very important in the diagnosis of carbon monoxide poisoning. The patient should be followed up with laboratory examinations and imaging methods such as magnetic resonance imaging in order not to overlook neurological sequelae or any organ injury. Additionally hyperbaric oxygen treatment performed in acute period and goal-directed therapy decrease mortality and morbidity

Solid pseudopapillary tumor of the pancreas

Pankreasın solid psödopapiller tümörü (SPT) nadir görülen, patogenezi halen belirsiz ve cerrahi sonrası prognozu iyi olan bir pankreatik tümördür. 2005- 2011 yılları arasında kliniğimizde malignite nedeniyle pankreas cerrahisi uygulanan 190 hastanın 3 (%1,5)üne histopatolojik olarak SPT tanısı kondu. Hastaların başvuru şikayeti nonspesifik karın ağrısı olup üçüde kadın idi. Tümör iki hastada pankreas kuyruğunda, bir hastada ise pankreas baş kesiminde idi. İki hastaya distal pankreatektomi ve splenektomi, bir hastaya ise pankreatikoduodenektomi yapıldı. Tüm hastalarda R0 rezeksiyon sağlandı. Patolojik incelemede tüm hastalarda cerrahi sınır negatif olup lenf nodu metastazı ve damar ya da sinir invazyonu saptanmadı. Sonuç olarak pankreasın solid pseudopapiller tümörleri nadir görülen ancak tedavi edilebilir pankreas tümörleridir.Solid pseudopapillary tumor of the pancreas (SPT) is a rare pancreatic tumor whose pathogenesis is yet to be known and which has a good post-op prognosis. 3 (1.5%) out of 190 patients who had pancreatic surgery because of malignity at our clinic between 2005 and 2011 were histopathologically diagnosed with SPT. The presenting complaints of the patients were non-specific abdominal pain and they were all female. The tumor was at the pancreatic tail in two patients, while it was at the head in one patient. Two patients had distal pancreatec- tomy and splenectomy, while one had pancreaticoduo- denectomy. R0 resection was achieved in all patients. Pathological analysis revealed that the surgical border was negative in all patients and no lymph node metastasis and vein or nerve invasion were observed. In conclusion, solid pseudopapillary tumors of the pancreas are but treatable pancreatic tumors

Relationship of preoperative neutrophil lymphocyte ratio with prognosis in gastrointestinal stromal tumors

Amaç: Gastrointestinal stromal tümörlerin lokal etkileriyle immünsupresyonda rol oynadığı düşünülmektedir. İnflamasyonla ilişkili bazı kanserlerde tedavi öncesi nötrofil lenfosit oranındaki artış kötü prognozun göstergesi olarak kabul edilmektedir. Çalışmamızın amacı gastrointestinal stromal tümör hastalarında kan nötrofil lenfosit oranı ile hastalığın prognozunu değerlendirmektir. Gereç ve Yöntemler: Kliniğimizde primer gastrointestinal stromal tümör nedeniyle cerrahi uygulanan 78 hastanın verileri retrospektif olarak değerlendirildi. Hastaların operasyon öncesi periferik kandan bakılan nötrofil lenfosit oranları belirlendi. Nötrofil lenfosit oranı ile tümör riski ve prognoz arasındaki ilişki karşılaştırıldı. Verilerin değerlendirilmesinde Pearson korelasyon analizi ve ANOVA Welch testi kullanıldı. Bulgular: Preoperatif nötrofil lenfosit oranındaki artış patolojik olarak yüksek riskli gastrointestinal stromal tümör gruplarında anlamlıydı (p0,05). Preoperatif nötrofil lenfosit oranı yüksek olan hastaların sağkalımları düşüktü (r- 0,32, p0,009). Ayrıca nötrofil lenfosit oranı artışı ile tümör mitotik aktivitesi artışı benzerdi (r-0,364, p0,025). Sonuç: Gastrointestinal stromal tümörlerde preoperatif nötrofil lenfosit oranı yüksek riskli tümörlerin belirlenmesinde ve kötü prognozun göstergesi olarak kullanılabilecek bir parametredir.Objective: Gastrointestinal stromal tumors are believed to play a role in immunosuppression with their local effect. In some cancers with associated inflammation, an increased pretreatment neutrophil lymphocyte ratio is considered as an indicator of poor prognosis. The aim of our study was to assess the relationship of increased blood neutrophil lymphocyte ratio with disease prognosis in patients with gastrointestinal stromal tumors. Material and Methods: The data of 78 patients who underwent surgery with the diagnosis of primary gastrointestinal stromal tumor in our clinic were evaluated retrospectively. The preoperative neutrophil lymphocyte ratio in the peripheral blood was determined. The neutrophil lymphocyte ratio and its relationship with tumor risk and prognosis were compared. The data were evaluated by Pearson's correlation analysis and the Welch ANOVA test. Results: The preoperative neutrophil lymphocyte ratio was significantly increased in the high-risk groups (p>0.05). An increased preoperative neutrophil lymphocyte ratio was associated with shorter survival (r-0.32, p0.009). In addition, an increase in the neutrophil lymphocyte ratio was associated with an increase in the mitotic activity of the tumor (r-0.364, p0.025). Conclusion: The preoperative neutrophil lymphocyte ratio in gastrointestinal stromal tumors can be used as an indicator of high-risk tumors and poor prognosis