Serous Cystadenoma of the Pancreas Presenting as a Third Primary Neoplasm

Serous cystadenomas are the most common cystic neoplasms of the pancreas. They may occur solely or coexist with other neoplasms. A 10 cm mass involving the body of the pancreas was observed in the computed tomography of a 61-year-old man with a previous history of bladder and prostate carcinoma. Ultrasonography and computed tomography of the mass demonstrated multiple small cysts associated with a central calcified scar. A distal pancreatectomy was performed. Pathological examination confirmed the diagnosis of serous microcystic adenoma. This is the first report of a serous cystadenoma of the pancreas with two metachronous neoplasms. This feature should be kept in mind during the diagnosis and evaluation of patients with serous cystadenoma

The Neutrophil-to-Lymphocyte Ratio as A Noninvasive Marker in Patients with Biopsy-Proven Non-Alcoholic Steatohepatitis

Amaç: Non-alkolik yağlı karaciğer hastalığı dünya çapında prevalansı artan önemli bir sağlık sorunudur. Nötrofil lenfosit oranı basit kan sayımı ile hesaplanabilecek ucuz bir inflamasyon belirtecidir. Bu çalışmada non-alkolik steatohepatit ve basit karaciğer yağlanması olan hastalarda nötrofil lenfosit oranının araştırılması ve sağlıklı kontrollerle karşılaştırılması amaçlanmıştır. Yöntemler: Karaciğer biyopsisi ile tanı konmuş 15 non-alkolik steatohepatit hastası, abdominal ultrasonografiyle tanı konmuş 65 basit karaciğer steatozu hastası ve 65 sağlıklı kontrol çalışmaya dahil edildi. Hastalara fizik muayene yapılarak antropometrik ölçümler alındı. Rutin laboratuar tetkikleri sırasında bakılan hemogramlar kullanılarak nötrofil lenfosit oranı hesaplandı ve çeşitli klinik ve laboratuar parametrelerle ilişkisi araştırıldı. Bulgular: Ortalama nötrofil lenfosit oranı non-alkolik steatohepatit gurubunda 2,160,49, basit steatoz gurubunda 1,620,43 ve sağlıklı kontrollerde 1,510,31 olarak saptanmış olup üç grup arasındaki fark istatistiksel olarak anlamlıydı (p0,001). İkili karşılaştırmalarda nötrofil lenfosit oranı açısından non-alkolik steatohepatit grubu ile hem basit steatozlar hem de sağlıklı kontroller arasındaki farkın istatistiksel olarak anlamlı olduğu (her ikisi için de p0,001) ancak basit steatoz grubu ile sağlıklı kontroller arasında fark olmadığı (p0,086) saptandı. Nötrofil lenfosit oranı ile abdominal ultrasonografideki yağlanma derecesi ya da karaciğer biyopsi bulguları arasında ilişki saptanmadı (p0,05). Yapılan ROC analizlerinde non-alkolik steatohepatit hastalarını ayırt etmesi açısından nötrofil lenfosit oranı için AUC0,868 (%95 güven aralığı: 0,781-0,956) ve seçilen 1,793 eşik de- ğeri için hesaplanan sensitivite %86,5 ve spesifite %81 olarak bulundu. Sonuç: Bu çalışmada nötrofil lenfosit oranının non-alkolik steatohepatit hastalarında gerek basit karaciğer steatozu olan hastalardan gerekse sağlıklı kontrollerden daha yüksek olduğu ancak basit steatoz gurubuyla sağlıklı kontroller arasında fark olmadığı saptandı. Bu da nötrofil lenfosit oranındaki artışın non-alkolik steatohepatite bağlı hepatik inflamasyon ve eşlik eden düşük düzey bir sistemik inflamasyon nedeniyle olabileceğini akla getirmektedirObjective: Non-alcoholic fatty liver disease is a global health problem with an increasing prevalence. The neutrophil-to-lymphocyte ratio is a cheap inflammatory parameter that can be easily calculated from routine complete blood count tests. This study was designed to investigate the neutrophil-to-lymphocyte ratio in patients with nonalcoholic steatohepatitis and simple hepatosteatosis. Methods: Fifteen patients with biopsy-proven non-alcoholic steatohepatitis, 65 patients with simple steatosis diagnosed with abdominal ultrasound, and 65 healthy controls were included. Anthropometric measurements were obtained during a routine physical examination. The neutrophil-to-lymphocyte ratio was calculated from routine complete blood count tests, and its relationship with various clinical and laboratory parameters was analyzed. Results: The mean neutrophil-to-lymphocyte ratio was 2.16±0.49 in the patients with non-alcoholic steatohepatitis, 1.62±0.43 in the patients with simple steatosis, and 1.51±0.31 for healthy controls; the difference among the groups of patients were statistically significant (p>0.001). A paired analysis revealed that patients with non-alcoholic steatohepatitis had a significantly higher neutrophil-to-lymphocyte ratio than patients with simple steatosis and healthy controls, whereas the difference between the latter two groups of patients was not statistically significant. The neutrophil-to-lymphocyte ratio was not associated with the degree of steatosis on performing abdominal ultrasound and with histological findings of liver biopsies (p<0.05). ROC analyses for the neutrophil-to-lymphocyte ratio to differentiate patients with steatohepatitis revealed an AUC of 0.868 (95% CI: 0.781-0.956) and 86.5% sensitivity and 81% specificity for the selected cut-off value of 1.793. Conclusion: The results of this study showed that the neutrophil-to-lymphocyte ratio was higher in patients with steatohepatitis than in patients with simple steatosis and healthy controls. Taking into account that the difference between patients with simple steatosis and healthy controls was not statistically significant, the increased neutrophil-to-lymphocyte ratio in the patients with steatohepatitis can be attributed to a low level of systemic inflammation accompanying the hepatic inflammatio

Successful endoscopic treatment of an unusual foreign body in the stomach: A package of heroin

WOS:000407527600015PubMed ID: 28762460Drug addiction is an important medical and social problem. “Body packing” is frequently used for concealed transportation of illegal drugs. The drug is packed in small plastic packages and swallowed or placed into body cavities, such as the rectum or the vagina. Another aspect is “body stuffing,” in which the drug package is usually hastily swallowed in order to avoid arrest. Presently described is case of a body stuffer who ingested a package of heroin and was successfully treated with upper gastrointestinal endoscopy. Upper gastrointestinal endoscopy is a safe alternative therapeutic option in body stuffers in selected case

Serum Solubl TWEAK Konsantrasyonu Hepatoselüler Kanser Hastalarında Azalmıştır ve Düşük Kan sTWEAK Düzeyleri Kötü Sağkalımla İlişkilidir

WOS:000404831400007Kötü Sağkalımla İlişkilidirTumor necrosis factor-like weak inducer of apoptosis (TWEAK) tümör nekrozis factor ailesinin bir üyesidir ve birçok kanserin patogenezinde rol oynadığı öne sürülmüştür. Bu çalışmada hepatoselüler kanser (HCC) hastalarında serum sTWEAK düzeylerinin araştırılması amaçlanmıştır. Yirmi sekiz HCC hastası, 28 siroz hastası ve 30 sağlıklı kontrol çalışmaya dahil edilerek serum sTWEAK konsantrasyonları ELISA yöntemiyle hazır kitler kullanılarak çalışılmıştır. HCC, siroz ve sağlıklı kontrol gruplarında ortalama serum sTWEAK konsantrasyonları 174.069.9 pg/ml, 221.461.2 pg/ml ve 288.068.4 pg/ml olup gruplar arasındaki fark istatistiksel olarak anlamlıydı (p 0.001). HCC grubundaki ortalama sTWEAK konsantrasyonunun gerek siroz (p 0.009) gerek de sağlıklı kontrol (p 0.001) gruplarından daha düşük olduğu görüldü. ROC analizinde, sTWEAK için 1 yıllık mortaliteyi öngörme açısından eğri altında kalan alan 0.836 (%95CI: 0.684-0.987) ve belirlenen148,1 pg/ml eşik değeri için duyarlılık ve özgüllük %66.7 ve %92.3 olarak bulundu. Kaplan-Meier sağkalım analizi ile serum sTWEAK konsantrasyonu 148,1 pg/ml olan hastalarda 1 yıllık sağkalım hızının anlamlı olarak daha düşük olduğu görüldü (log-rank testi, ?2 11.75, p 0.001). Cox regresyon analizinde de serum sTWEAK konsantrasyonunun mortaliteyi öngören bağımsız bir risk faktörü olduğu görüldü (Hazard oranı 4.325, %95 CI: 1.080-17.326, p 0.025). HCC hastalarında serum sTWEAK konsantrasyonu azalmıştır. Düşük serum sTWEAK düzeyleri, HCC hastalarında kötü prognoz ve yüksek bir yıllık mortalite oranlarıyla ilişkilidirTumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of the tumor necrosis factor superfamily and has been implicated in the pathogenesis of several cancers. This study was conducted to investigate serum sTWEAK levels and its relation with prognosis in patients with hepatocellular carcinoma (HCC). Twenty-eight cirrhotic patients with HCC, 28 patients with cirrhosis and 30 healthy subjects were included in the study. Serum sTWEAK concentrations were measured by using commercially available enzyme-linked immune sorbent assay kits. Mean serum sTWEAK concentrations in HCC, cirrhosis and healthy control groups were 174.069.9 pg/ml, 221.461.2 pg/ml and 288.068.4 pg/ml respectively and the difference between the groups was statistically significant (p 0.001). Mean sTWEAK concentration in the HCC group was significantly lower than both cirrhosis group (p 0.009) and healty controls (p 0.001). In the ROC curve analysis, AUC for serum TWEAK concentration to predict one-year mortality in HCC patients was 0.836 (95% CI: 0.684-0.987) and for the specified cut-off value of 148.1 pg/ml, sensitivity and specificity were 66.7% and 92.3% respectively. Kaplan-Meier survival estimates showed that, survival rate was significantly lower in patients with serum sTWEAK 148.1 pg/ml (log-rank test, ?2 11.75, p 0.001). Serum sTWEAK concentration was identified as an independent predictor of mortality in Cox regression analysis (Hazard ratio 4.325, 95% CI: 1.080-17.326, p 0.025). Serum sTWEAK concentration is decreased in HCC patients. Lower serum sTWEAK concentrations at the time of diagnosis are associated with poor prognosis and higher one-year mortality rates in HCC patient

Serum ischemic modified albumin (IMA) concentration and IMA/albumin ratio in patients with hepatitis B-related chronic liver diseases

Background/aim: Albumin is the most important protein synthesized by the liver. Posttranscriptional changes occur in the molecular structure of albumin due to various factors and isoforms arise. Ischemic modified albumin (IMA) is one such isoform. This study was conducted to evaluate serum IMA concentrations in patients with hepatitis B virus (HBV)-related chronic liver diseases. Materials and methods: This study included 74 treatment-naive chronic hepatitis B patients, 25 patients with HBV-related cirrhosis, and 49 healthy controls. Serum IMA concentration was measured spectrophotometrically using the albumin cobalt binding test. Results: The mean IMA concentrations in the chronic hepatitis B group and healthy controls were 0.33 ± 0.11 ABSU and 0.27 ± 0.70 ABSU, respectively, and the difference was statistically significant (P > 0.001). Mean IMA/albumin ratios (IMAR) in the chronic hepatitis B and control groups were 0.08 ± 0.04 and 0.06 ± 0.17, respectively, and the difference was also statistically significant (P > 0.001). Higher serum IMA concentrations and IMAR were detected in patients with advanced fibrosis. Conclusion: Serum IMA concentration and IMAR are increased in patients with HBV-related chronic liver diseases and IMA and IMAR are associated with the degree of liver fibrosis. IMA and IMAR may have potential use as noninvasive markers of fibrosis in chronic hepatitis B patients

Dynamic thiol-disulfide homeostasis is disturbed in hepatitis B virus-related chronic hepatitis and liver cirrhosis

WOS:000452889200014PubMed ID: 30384565Background/aim: Thiol-disulfide homeostasis is an important antioxidant defense mechanism. This study was conducted to investigatedynamic thiol-disulfide homeostasis in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis.Materials and methods: Seventy-one treatment-naive patients with chronic hepatitis B (CHB), 50 patients with hepatitis B virusassociated liver cirrhosis, and 45 healthy controls were included in the study. Serum total and native thiol concentrations and serumdisulfide concentrations were measured using an automated method.Results: Mean serum total thiol concentrations in the control, CHB, and cirrhosis groups were 481.64 37.87 µmol/L, 438.50 71.35µmol/L, and 358.07 80.47 µmol/L, respectively (P 0.001), and mean serum native thiol concentrations in the control, CHB, andcirrhosis groups were 452.92 36.43 µmol/L, 400.16 65.92 µmol/L, and 328.15 74.91 µmol/L, respectively (P 0.001). Mean serumdisulfide concentrations in the control, CHB, and cirrhosis groups were 14.38 3.38 µmol/L, 19.19 6.16 µmol/L, and 14.98 5.53µmol/L, respectively (P 0.001). There was a progressive decrease in both mean serum native and total thiol concentrations parallel tothe liver fibrosis stage.Conclusion: : Thiol-disulfide homeostasis is disturbed in patients with hepatitis B virus-related chronic hepatitis and liver cirrhosis

Üst Gastrointestinal Endoskopi İşlemi Öncesi HBsAg, Anti HCV ve Anti HIV Prevalansları

Amaç: Bu çalışma dispeptik yakınmalar ile başvuran ve üst gastrointestinal endoskopi incelemesi önerilen hastalarda yapıldı. Çalışmanın amacı endoskopi işlemi öncesi hastalarda hepatit serolojisi ve Anti HIV serolojisini taramak ve prevalansını değerlendirmek, bunun sonucunda işlem öncesinde rutin seroloji isteminin gerekliliğini tartışmaktır. Gereç ve Yöntemler: Çalışma 2012 yılında Konya Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji polikliniğine başvuran ve işlem öncesi hepatit ve HIV serolojisi bakılan toplam 242 hastayı kapsamaktadır. Bulgular: Çalışmaya alınan toplam 242 hastanın; 120si erkek (%49), 122si kadın (%50) idi. Seropozitiflik oranları HBsAg %2,9, Anti HCV %0,4 iken Anti HIV pozitifliğine rastlanmadı. Toplamda hastaların %3,3 de hepatit serolojisi pozitif tespit edildi. Sonuç: Hastanemizde endoskopi işlemi öncesi bakılan hepatit serolojisi oranlarının toplum prevalansına yakın değerlerde çıktığı görülmüştür, endoskopik işlemler sonrası hepatit bulaşının son derece nadir olduğu da göz önüne alınırsa endoskopi ünitelerinde yeterli dezenfeksiyon uygulamalarına riayet edilmesi takdirinde rutin serolojik testlerin gereksiz olduğu kanısına ulaşılmaktadır.Objectıve: This study was conducted to determine the preprocedure prevalence of hepatitis B, hepatitis C and HIV in patients with dyspeptic complaints to whom an upper gastrointestinal endoscopy was performed and also to question the necessity of routine serologic testing. Materials and Methods: Medical records of 242 adult patients who applied to Gastroenterology clinic of Necmettin Erbakan University Meram Faculty of Medicine with dyspeptic complaints during 2012 and to whom an upper gastrointestinal endoscopy was performed were analyzed retrospectively for preprocedure hepatitis B, hepatitis C and HIV serologies. Results: A total of 242 patients were taken into the study. 120 of them (49%) were males and 122 of them (51%) were females. Preprocedure prevalence of HBs Ag and anti HCV was 2.9% and 0.4% respectively. Anti HIV was detected to be positive in none of the patients. In total 3.3% of patients were positive hepatitis serology. Conclusion: The preprocedure prevalence of hepatitis B and C in our patients was consistent with the prevalences reported for general population in previous studies. Taken into account that post procedure transmission of hepatitis B and C is rare, routine serologic testing is not necessary as far as disinfection rules are obeyed strictly in endoscopy clinics

Kronik Hepatit C’de Üçlü Tedavi: Bir Üniversite Hastanesi Gastroenteroloji Kliniğinin Deneyimi

Amaç: Pegile interferonribavirin kombinasyonu uzun yıllar kronik hepatit C tedavisinde standart tedavi olmuştur. Son yıllarda proteaz inhibitörleri bu kombinasyona ilave edilmiş ve daha yüksek kalıcı virolojik yanıt oranları elde edilebilmiştir. Biz bu çalışmada kliniğimizde takip edilen ve PEG-İFNribavirinproteaz inhibitörü içeren üçlü tedavi alan hastalarımızın verilerini retrospektif olarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji Kliniğine Aralık 2012-Aralık 2015 tarihleri arasında başvuran ve proteaz inhibitörü içeren 3'lü tedavi verilen 23 kronik HCV hastasının verileri retrospektif olarak incelenmiştir.Bulgular: Hastaların 18'i (%78,3) kadın ve 5'i (%21,7) erkek ve median yaşları 58 yıl (Aralık 42-70 yıl) idi. Toplam 16 hastada (%69,6) kalıcı virolojik yanıt elde edilmişti. Telaprevir kullanan 18 hastanın 13'ünde (%72,2) ve boseprevir kullanan 5 hastanın 3'ünde (%60) kalıcı virolojik yanıt elde edildi. Daha önce PEG IFNribavirin ikili tedavisi alıp nüks olan 11 hastanın 10'unda (%90,1), kısmi yanıt veren 3 hastanın tamamında ve ilk tedavide primer yanıtsız olan 4 hastanın 2'sinde (%50) kalıcı virolojik yanıt elde edildi. Sirotik olan 9 hastanın 7'si (%77,8) planlanan tedavi süresini tamamladı, 5 hastada (%55,6) kalıcı virolojik yanıt elde edildi. Sirozu olmayan 14 hastanın 12'si (%85,7) tedaviyi tamamlarken, bu hastaların 11'inde (%78,5) kalıcı virolojik yanıt elde edildi. 4 hastada (%17,4) çeşitli yan etkiler nedeniyle tedavi süresi tamamlanamadı.Sonuç: İnterferonsuz tedavi rejimlerinin ülkemizde henüz rutin kullanıma girmediği göz önüne alınırsa, seçilmiş vakalarda PEG IFN, ribavirin ve bir proteaz inhibitörü içeren üçlü tedavilerin hala bir seçenek olabileceği kanaatindeyiz.Objective: Pegylated interferonribavirin dual combination had been the standard treatment for chronic hepatitis C for years.Recently protease inhibitors were added to this combination.In this manuscript, we aimed to review the data of the patients to whom Pegylated interferonribavirinprotease inhibitor containing triple therapy regimen were given in our clinic.Material and Method: This was a retrospective study and 23 chronic hepatitis C patients treated with triple therapy regimen in Necmettin Erbakan University, Meram Faculty of Medicine, Department of Gastroenterology, between December 2012 and December 2015 were included.Results: There were 18 (78.3%) male and 5 (21.7%) female patients and median age was 58 years (range 42-70 years). 16 (69.6%) patients achieved sustained virological response. Thirteen (72.2%) of 18 patients on telaprevir regimen and 3 (60%) of 5 patients on boceprevir regimen achieved sustained virological response.When virological response in the prior pegylated interferonribavirin treatment was taken into consideration;10 (90.1%) of 11 patients with relapse,3 patients (100%) with partial response and 2 (50%) of 4 non-responders were found to achieve sustained virological response. Seven (77.8%) of 9 cirrhotic patients completed the planned treatment and sustained virological response was achieved in 5 (55.6) patients. 12 (85.7%) of 14 non-cirrhotic patients completed the planned treatment and sustained virological response was achieved in 11 (78.5%) patients.Treatment was discontinued in 4 (17.4%) patients due to various side effects.Conclusion: Taking into consideration that novel interferon free treatment regimens are not available in our country yet, triple combination with Pegylated interferonribavirin and protease inhibitor is still a treatment option for chronic hepatitis C in selected cases

A polypoid mass in the common bile duct

WOS:000388698100004PubMed ID: 27852536

Serous Cystadenoma of the Pancreas Presenting as a Third Primary Neoplasm

Serous cystadenomas are the most common cystic neoplasms of the pancreas. They may occur solely or coexist with other neoplasms. A 10 cm mass involving the body of the pancreas was observed in the computed tomography of a 61-year-old man with a previous history of bladder and prostate carcinoma. Ultrasonography and computed tomography of the mass demonstrated multiple small cysts associated with a central calcified scar. A distal pancreatectomy was performed. Pathological examination confirmed the diagnosis of serous microcystic adenoma. This is the first report of a serous cystadenoma of the pancreas with two metachronous neoplasms. This feature should be kept in mind during the diagnosis and evaluation of patients with serous cystadenoma