On yılı kapsayan duedonal biyopsi kayıtlarının modifiye Marsh klasifikasyonu

Amaç: Çöliak hastalığı, buğday, arpa ve yulaf gibi tahıllı gıdalarda bulunan, gluten proteinleri ile oluşan, toplumun %1 inden fazlasının etkilendiği, ince barsak enflamasyonu ile karekterize otoimmün bir hastalıktır. Çöliak hastalığında mukozal hasar, otoimmün kompenenti olan, aynı zamanda T hücre aracılı, kronik enflamatuvar hastalık olarak kabul edilen, dinamik bir süreçtir. Bu çalışmanın amacı, 10 yıl içerisinde bölümümüze gelen duedonal biopsilere Modifiye Marsh Klasifikasyonunu uygulamaktır. Bu çalışmanın amacı, daha önce tespit edilemeyen düşük dereceli çöliak olgularının ortaya çıkarılmasıdır. Materyal ve Metod: 467 biopsi alındı ve 2 patolog tarafından değerlendirildi (2001 ile 2011 yılları arasında Çukurova Üniversitesi Tıp Fakültesi, Patoloji anabilim dalında tanıları konuldu). Her bir örnek daha önce rapor edilen tanılar göz önüne alınmaksızın yeniden değerlendirildi. Bulgular: Modifiye Marsh Klasifikasyonuna göre 48 olgu Tip 1 çöliak tanısı konuldu. Modifiye Marsh Klasifikasyonuna göre 6 olguya Tip 2 çöliak tanısı konuldu. Toplam 11 olguya Modifiye Marsh Klasifikasyonuna göre Tip3a çöliak tanısı konuldu. Toplam 5 olguya Modifiye Marsh Klasifikasyonuna göre Tip 3b çöliak tanısı konuldu. Toplam 6 olguya Modifiye Marsh Klasifikasyonuna göre Tip 3c çöliak tanısı konuldu. Sonuç: Bu çalışma, Modifiye Marsh Klasifikasyonunun klinik şüpheli olgularda duedonal biopsilerin değerlendirilmesinde önemli bir standartizasyon getirdiğini, erken olguların değerlendirilmesinde çok yararlı olduğunu ortaya koymuştur.Purpose: Celiac is an autoimmune disease caused by of gluten proteins which can be found in multi-grain food like wheat, barley and oat. The disease affects more than 1% of population and characterized by intestinal inflammation. In celiac disease, mucosal damage is a dynamic process. It is shown that it has autoimmune components. It is also T-Cell mediated and can be categorised as a chronic inflammatory disease. The purpose of this study is to make modified Marsh classification of the duodenal biopsies that came to our department in the 10 years. The study deals with reassessment of all events and uncovering the low graded events that were not diagnosed. Material and Methods: 467 biopsies (diagnosed between 2001 and 2011 at the Cukurova University, Faculty of Medicine, Department of Pathology) were taken and analyzed by two pathologists. Each sample was reevaluated without taking the previous reports into consideration and scored by using modified Marsh classification. Results: According to Modified Marsh Classification total of 48 cases were diagnosed as Type 1. Total of 6 cases according to Modified Marsh Classification was diagnosed as Type 2. Total of 11 cases according to Modified Marsh Classification was diagnosed as Type 3a. Total of 5 cases, according to Modified Marsh Classification, was diagnosed as Type 3b. Total of 6 cases according to Modified Marsh Classification was diagnosed as Type 3c. Conclusion: As a result of this study, it has been found that Modified Marsh Classification is a very important standardization tool for detection of suspicious duodenal biopsies and for early case examinations

Hepatitis B Virus Belated Reverse Sero-conversion After Hematopoietic Stem Cell Transplantation or Rituximab Chemotherapy

Recovery and immunity to hepatitis B virus (HBV) are marked by antibody to hepatitis B core antigen (anti-HBc) with or without antibody to hepatitis B surface antigen (anti-HBs) in the absence of hepatitis B surface antigen (HBsAg). In the profoundly immune compromised individual, HBV may reactivate even in the presence of serologic evidence of resolved infection. The loss of anti-HBs followed by reactivation with development of HBsAg is known as reverse sero-conversion. A 62-year-old female patient with the diagnosis of IgG type of multiple myeloma had received bortezomib-based chemotherapy, and autologous hematopoietic stem cell transplantation (HSCT) was performed thereafter. A 56-year-old male patient with the diagnosis of chronic lymphocytic leukemia had received 6 cures of rituximab-endoxan chemotherapy. Prior to chemotherapy, HBsAg was negative, anti-HBs positive, anti- HBc positive and HBV-DNA was negative in both patients. Approximately one year after chemotherapy, HBV reverse sero-conversion developed in both patients. Resolved HBV infection with undetectable HBV-DNA before chemotherapy or HSCT did not confer HBV reverse sero-conversion. Prior to the creation of regular follow-up or prophylaxis schemes of patients with resolved HBV infection, in whom immune suppressive and anti-cancer treatments or HSCT will be performed, close follow-up of patients for HBV reverse sero-conversion even in late stages after immune suppressive and anti-cancer treatments or HSCT seems beneficial, especially in regions with intermediate or high endemicity for HBV

Hemosuccus pancreaticus A case report and review of the literature

Hemosuccus pancreaticus is a rare clinical condition, defined as a bleeding from an artery around the pancreas or a lesion on the pancreas, to the pancreatic duct. The intensity of bleeding can vary from occult bleeding to life threatening massive acute bleeding. In this article, we aimed to present a 68-year-old man who presented to our clinic with recurrent upper gastrointestinal bleeding and abdominal pain. Endoscopy revealed hemorrhage from ampulla vateri, CT angiographic examination showed an aneurysm of the splenic artery and that the splenic artery was connected to the pancreatic duct.Splenectomy and subtotal pancreatectomy was performed on the patient. The patient was discharged with healing. Hemosuccus pancreaticus should be kept in mind in patients with a history of pancreatitis and peripancreatic aneurysm and upper gastrointestinal bleeding. The early diagnosis and treatment of HP is life-saving. In this study, we aimed to review the basic symptoms and clinical findings, along with the diagnosis and treatment methods of HP

Zor safra kanalı taşının en Önemli belirteçleri

Giriş ve Amaç: Safra kanalı taşlarının tedavisinde endoskopik retrograd kolanjiopankreatografi standard tedavi haline gelmiş- tir. Bu hastalarda endoskopik retrograd kolanjiopankreatografinin teknik güçlüğünü araştıran küçük hasta grupları ile yapılmış az sayıda çalışma vardır. Bu çalışmada biz bu faktörleri geniş bir hasta grubunda araştırmayı amaçladık. Gereç ve Yöntem: İki yıllık bir süre içerisinde endoskopik retrograd kolanjiopankreatografi yapılan tüm naive hastalar (n=1850) prospektif olarak değer- lendirildi. Taş çıkartmak için birden fazla endoskopik retrograd kolanjiopankreatografi seansı, mekanik litotripsi, ekstra şok dal- ga litotripsi gerektiren ya da endoskopik olarak çıkarılamayıp cerrahiye giden hastalar zor taşı olan hastalar olarak kabul edildi. Yaş, cinsiyet, labaratuvar parametreler, endoskopik ve kolanjiografik bulgular kayıt edildi. Zor için prediktif faktörler univariate ve multivariate analizlerle araştırıldı. Bulgular: Çalışma grubu oralama 60±16 yaşında 431 kadın 325 erkek hastadan oluştu. 757 hastanın 654'ünde (86,4%) kolay taş, 103'ünde (13,6%) zor taş var idi. Hastaların %98,1'inde endoskopik taş çıkarma işlemi başarılı idi. Taşın ötesinde darlık olması (OR: 8,248), küçük ortak safra kanalı/taş çapı oranı (OR: 0,348), taş çapı (OR: 1,187), taşınstone impakte olması (OR: 1,117) ve yüksek bilirubin değerleri (OR: 1,1) zor taş için multivariate analizde bağımsız be- lirleryici faktörler olarak tespit edildi. Sonuç: Ortak safra kanalı taşları tedavisinde endoskopik retrograd kolanjiopankreatogra- fi çok etkili bir yöntemdir. Taşın ilerisinde darlık olmasının yanında küçük safra kanalı/taş çapı oranı, taş çapı, impakte taş ve yüksek bilirubin değerleri zor taş için önemli belirteçlerdirBackground/aims: Endoscopic retrograde cholangiopancreatography has become the standard treatment for common bile duct stones worldwide. However, there are only a few reports with small number of patients concerning the factors that contribute to the technical difficulty of endoscopic retrograde cholangiopancreatography in these patients. In this study we aimed to investigate these factors in a large group of patients. Materials and Methods: All patients with a naıïve papilla (n=1850) who underwent endoscopic retrograde cholangiopancreatography during a study period of 2 years were prospectively evaluated. Of these, 757 patients with com- mon bile duct stones were included in the study. Following successful cannulation, patients who needed either more than one episode for stone extraction or mechanical lithotripsy, extracorporeal shock wave lithotripsy, or patients in whom stone extraction could not be achieved endoscopically and underwent surgery were regarded as having “difficult stones”. Age, sex, laboratory parameters, endo- scopic and cholangiographic findings were recorded in all patients. Predictive factors for difficult stones were investigated using univariate and multivariate analysis. Results: The study group consisted of 432 women and 325 men with a mean age of 60±16 years . Of the total 757 patients, 654 (86.4%) had easy and 103 (13.6%) had difficult stones. Endoscopic stone extrac- tion was successful in 98.1% of patients. A stricture distal to the stone (OR: 8.248), smaller common bile duct/stone diameter ratio (OR: 0,348), stone diameter (OR: 1,187) stone impaction (OR: 1,117) and higher bilirubin levels (OR: 1,1) were found to be inde- pendent predictors of difficult stone extraction on multivariate analysis. Conclusion: Endoscopic retrograde cholangiopancreatog- raphy is a very effective method for the treatment of common bile duct stones. Presence of a stricture distal to the stone, smaller com- mon bile duct/stone diameter ratio, stone diameter, impacted stone, and higher bilirubin levels are significant predictors of diffi- cult ston

Major predictors for difficult common bile duct stone

Giriş ve Amaç: Safra kanalı taşlarının tedavisinde endoskopik retrograd kolanjiopankreatografi standard tedavi haline gelmiş- tir. Bu hastalarda endoskopik retrograd kolanjiopankreatografinin teknik güçlüğünü araştıran küçük hasta grupları ile yapılmış az sayıda çalışma vardır. Bu çalışmada biz bu faktörleri geniş bir hasta grubunda araştırmayı amaçladık. Gereç ve Yöntem: İki yıllık bir süre içerisinde endoskopik retrograd kolanjiopankreatografi yapılan tüm naive hastalar (n=1850) prospektif olarak değer- lendirildi. Taş çıkartmak için birden fazla endoskopik retrograd kolanjiopankreatografi seansı, mekanik litotripsi, ekstra şok dal- ga litotripsi gerektiren yada endoskopik olarak çıkarılamayıp cerrahiye giden hastalar zor taşı olan hastalar olarak kabul edildi. Yaş, cinsiyet, labaratuvar parametreler, endoskopik ve kolanjiografik bulgular kayıt edildi. Zor için prediktif faktörler univariate ve multivariate analizlerle araştırıldı. Bulgular: Çalışma grubu oralama 60±16 yaşında 432 kadın 325 erkek hastadan oluştu. 757 hastanın 654'ünde (%86.4) kolay taş, 103'ünde (%13.6) zor taş var idi. Hastaların %98.1'inde endoskopik taş çıkarma işlemi başarılı idi. Taşın ötesinde darlık olması (OR: 8.248), küçük ortak safra kanalı/taş çapı oranı (OR: 0.348), taş çapı (OR: 1.187), taşın impakte olması (OR: 1.117) ve yüksek bilirubin değerleri (OR: 1.1) zor taş için multivariate analizde bağımsız belir- leyici faktörler olarak tespit edildi. Sonuç: Ortak safra kanalı taşları tedavisinde endoskopik retrograd kolanjiopankreatografi çok etkili bir yöntemdir. Taşın ilerisinde darlık olmasının yanında küçük safra kanalı/taş çapı oranı, taş çapı, impakte taş ve yüksek bilirubin değerleri zor taş için önemli belirteçlerdir.Background/aims: Endoscopic retrograde cholangiopancreatography has become the standard treatment for common bile duct stones worldwide. There are only a few reports with small number of patients concerning the factors that contribute to the techni- cal difficulty of endoscopic retrograde cholangiopancreatography in these patients. In this study, we aimed to investigate these fac- tors in a large group of patients. Materials and Methods: All patients with naive papilla (n=1850) who underwent endoscopic ret- rograde cholangiopancreatography during a study period of 2 years were prospectively evaluated. Among them, 757 patients with common bile duct stones were included in the study. Following successful cannulation, the patients who needed either more than one episode for stone extraction or mechanical lithotripsy, extracorporeal shock wave lithotripsy or in whom stone extraction could not be achieved endoscopically and underwent surgery were regarded as having -difficult stones-. Age, sex, laboratory parameters, endoscopic and cholangiographic findings were recorded in all patients. Predictive factors for difficult stones were investigated in univariate and multivariate analysis. Results: The study group consisted of 432 women and 325 men with a mean age of 60±16 ye- ars . Of the total 757 patients, 654 (86.4%) had easy and 103 (13.6%) had difficult stones. Endoscopic stone extraction was successful in 98.1% of patients. Stricture distal to the stone (OR: 8.248), smaller common bile duct/stone diameter ratio (OR: 0.348), stone diameter (OR: 1.187), stone impaction (OR: 1.117), and higher bilirubin levels (OR: 1.1) were found to be independent predictors of difficult stone in multivariate analysis. Conclusion: Endoscopic retrograde cholangiopancreatography is a very effec- tive method for the treatment of common bile duct stones. Besides strictures distal to the stone, smaller common bile duct/stone di- ameter ratio, stone diameter, impacted stone, and higher bilirubin levels are significant predictors of difficult stone

Which prognostic marker is responsible for the clinical heterogeneity in CLL with 13q deletion?

Background: Deletion of 13q14 [del(13q)] is the most common cytogenetic change (50%) in chronic lymphoblastic leukemia (CLL), and it is a good prognostic factor if it is detected as a sole aberration by FISH. However, it is observed the clinical course of CLL cases with del(13q) are quite heterogeneous and the responsible for this clinical heterogeneity has not been established yet. Some investigators suggest type II deletion (include RB1 gene) is associated with more aggressive clinical course. Also, it is suggested that the deletion burden and the deletion type have a prognostic effect. In this study, we aimed to investigate the effect of RB1 gene deletion, deletion burden and deletion type on overall survival (OS), disease stage and time to first treatment (TTFT) in patients with isolated del(3q). Sixty eight cases, detected isolated del(13q) were included in the study. Also, RB1 deletion was analyzed from peripheral blood of them using FISH

Macroscopic Portal Vein Thrombosis in HCC Patients

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD 10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumormultifocality. A logistic regressionmodel that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD >5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development