Case Report: Hepatic Mass Caused By Fasciola Hepatica: A Tricky Differential Diagnosis

Fascioliasis is a zoonotic infestation caused by the trematode fasciola hepatica. It presents a wide spectrum of clinical pictures ranging from fever and eosinophilia to ambiguous gastrointestinal symptoms in the acute phase. However, it may often be overlooked, especially in the acute phase, because of uncertain symptoms. Fasciola hepatica can have an initial presentation similar to the presentation of malignancy. Here, we report a case of a hepatic mass caused by fasciola hepatica

Serum Tnf-Alpha Levels In Acute And Chronic Pancreatitis

Aim: Acute and chronic pancreatitis are inflammations of pancreatic tissue which have systemic effects and clinical presentations such as bacteremia and septic shock. Inflammatory markers have growing importance in diagnosis and identification of the severity of the pancreatitis. We aimed to determine TNF-alpha levels in acute and chronic pancreatitis and evaluate the relation between TNF-alpha levels and the pancreatic enzyme concentrations in two forms of the disease. Methods: 13 patients with acute pancreatitis, 36 patients with chronic pancreatitis and 14 healthy controls were included to our study. TNF-alpha determinations were performed with ELISA method. Results: TNF-alpha concentrations were 13.30±4.42 (7.04-21.35) pg/ml and 9.88±4.68 (3.99-27.73) pg/ml 10.09±1.01 (8.69-14.96) pg/ml in patients with acute and chronic pancreatitis and healthy controls respectively. TNF-alpha concentrations were significantly higher in patients with acute pancreatitis than the patients with chronic pancreatitis. But there was no significant difference between healthy controls and patients with either acute or chronic pancreatitis for TNF-alpha levels. There was no significant correlation between TNF-alpha concentrations and pancreatic enzyme levels. Conclusion: We concluded that in acute pancreatitis TNF-alpha levels were higher than the chronic form of the disease. But its concentrations did not correlate with the severity of the disease. By investigation of the other inflammatory markers and acute phase reactants with TNF-alpha, this process will be more clarified

Helikobakter pylori enfeksiyonu B12 eksikliğinin gerçekten bir nedeni midir?

Aim: Aim of this study is to determine Helicobacter pylori infection rate in Vitamin B12 deficiency and determine whether H.pylori infection is really actual cause of Vitamin B12 deficiency. Material and Methods: We evaluated 40 vitamin B12 deficient patients and 25 healthy subjects. Those patients did not have known cause of vitamin B12 deficiency. We performed endoscopic evaluation and pathological examination for H.pylori. We determined 50% atrophic gastritis in vitamin B12 deficient group, but we did not observe any atrophic gastritis in the control group endoscopically. Results: There were H.pylori positivity in 11/40 (27.5%) in the patients group but 16/25 (64) in the control group in pathological examination (p<0.01). Pathological examination of patient group also illustrated that 11 patients had mild atrophy in 11 (27.5%), 5 had moderate atrophy (12.5%) and 3 patient (7.5%) had severe atrophy. In contrast, 3 patients had only mild atrophy (12%) in the control group. We also found that H.pylori (-) 17/29 (58.6%) patients and H.pylori (+) 3/11 (27.3%) patients had atrophic gastritis in gastroscopic evaluation. Conclusion: Patients who have vitamin B12 deficiency had lower ratio of H.pylori in gastric mucosa. On the other hand, the patient group had higher ratio of atrophic gastritis in pathological and gastroscopic examination. H.pylori positivity had been decreased progressively with aging in patients group. H.pylori has disappeared in following years as a result of atrophy in gastric mucosa. We conluded that atrophic mucosa is not suitable for colonization of H.pylori infection. © 2011 Düzce Medical Journal

The association between insulin resistance and hepatic fibrosis in patients with chronic hepatitis C: An observational, multicenter study in Turkey

Background/Aims: To evaluate the association between insulin resistance and hepatic fibrosis in patients with chronic hepatitis C.Materials and Methods: A total of 104 chronic hepatitis C patients were included in this non-interventional, openlabel, observational, multicenter, cross-sectional study conducted at 20 gastroenterology clinics in Turkey. The primary end point was the correlation between stage of hepatic fibrosis and insulin resistance evaluated via the homeostasis model of assessment-insulin resistance index. Confounders of hepatic fibrosis and insulin resistance were the secondary end points. Results: The mean age of patients was 52.8 years; 65.4% were female. Type 2 diabetes was present in 6.8% and insulin resistance noted in 38.0% of patients. Further, 45.7% of the patients had mild (A0/A1) and the remaining had moderate/severe (A2/A3) hepatic necroinflammatory activity. Patient distribution according to Metavir fibrosis stage was as follows: F0/F1 (57.0%); F2 (6.5%); F3 (23.7%); and F4 (12.9%). A univariate analysis revealed significant positive correlations between Metavir fibrosis stage and insulin resistance (r=0.297; p=0.007). Logistic regression analysis showed that significant predictors of insulin resistance were high alanine transaminase levels (odds ratio, 0.97; 95% confidence interval, 0.944-0.997) and liver fibrosis stage (odds ratio, 0.114; 95% confidence interval, 0.0210.607).Conclusion: Our findings revealed significant associations between insulin resistance and hepatic fibrosis.Background/Aims: To evaluate the association between insulin resistance and hepatic fibrosis in patients with chronic hepatitis C.Materials and Methods: A total of 104 chronic hepatitis C patients were included in this non-interventional, openlabel, observational, multicenter, cross-sectional study conducted at 20 gastroenterology clinics in Turkey. The primary end point was the correlation between stage of hepatic fibrosis and insulin resistance evaluated via the homeostasis model of assessment-insulin resistance index. Confounders of hepatic fibrosis and insulin resistance were the secondary end points. Results: The mean age of patients was 52.8 years; 65.4% were female. Type 2 diabetes was present in 6.8% and insulin resistance noted in 38.0% of patients. Further, 45.7% of the patients had mild (A0/A1) and the remaining had moderate/severe (A2/A3) hepatic necroinflammatory activity. Patient distribution according to Metavir fibrosis stage was as follows: F0/F1 (57.0%); F2 (6.5%); F3 (23.7%); and F4 (12.9%). A univariate analysis revealed significant positive correlations between Metavir fibrosis stage and insulin resistance (r=0.297; p=0.007). Logistic regression analysis showed that significant predictors of insulin resistance were high alanine transaminase levels (odds ratio, 0.97; 95% confidence interval, 0.944-0.997) and liver fibrosis stage (odds ratio, 0.114; 95% confidence interval, 0.0210.607).Conclusion: Our findings revealed significant associations between insulin resistance and hepatic fibrosis

Fatal rhinocerebral mucormycosis under the shade of hepatic encephalopathy

Mucormycosis is an acutely fatal infection that occurs in immuncompromised patients. Cirrhosis is an acquired immune deficiency state and those patients are more prone to develop opportunistic infections. A 42-years-old cirrhotic man was admitted to our gastroenterology clinic with hepatic encephalopathy. Although he recovered from encephalopathy with supportive measurements, he developed paresthesia on the face. He was diagnosed with rhinocerebral mucormycosis and antifungal therapy was administered. Surgical treatment couldn’t be performed because of his bleeding diathesis and poor general condition. He succumbed on the 12th day of his admission