Low molecular weight heparin treatment of acute moderate and severe pancreatitis: A randomized, controlled, open-label study

Conclusion: Low molecular weight heparin treatment is safe and provides better prognosis in MSAP

Kemik ve Lenf Nodu Tutulumu ile Birlikte Yaygın Metastazı Olan Gastrointestinal Stromal Tümör

Gastrointestinal stromal tümörler (GİST), gastrointestinal traktusun en sık görülen mezenkimal tümörleridir. GİST’lerin; mide (%60), ince barsak (%30), kolon ve rektum (%5-10), daha azı (%1) ise özofagus, omentum, mezenter veya retroperitonal bölgelerden kaynaklanmaktadır. Tanı konulduğunda vakaların yaklaşık yarısı metastaz yapmış durumdadır ve en sık karaciğer (%50-60) ve peritona (%20-43) metastaz yaparlar. GİST’lerde kemik ve lenf nodu metastazı ise literatürde oldukça az sayıda bildirilmiştir. Sunulan olguda midede 22 cm çaplı GİST saptanmış ve cerrahi ile tamamen eksize edilmiştir. Operasyon sonrası değerlendirmede metastazı olmayan olguya, kütle boyutunun büyük oluşu (>10 cm) ve artmış mitoz sayısı (>5/10 hpf) nedeni ile yüksek riskli kabul edilerek imatinib tedavisi verilmiştir. İmatinib tedavisinin altıncı yılında karın ağrısı ve şişkinlik şikâyetleri ile başvuran hastada karaciğer, periton, kemik ve lenf nodlarında yaygın metastaz saptanmıştır. Bu çalışmada, tamamen çıkarılmış ve imatinib tedavisinin altıncı yılında atipik metastazlarla başvuran GİST’li olgu literatür eşliğinde gözden geçirilmişti

Prediction of Self-Limited Acute Pancreatitis Cases at Admission to Emergency Unit

Background: While acute pancreatitis (AP) resolves spontaneously with supportive treatment in most patients, it may be life-threatening. Predicting the disease severity at onset dictates the management strategy. We aimed to define the patients with mild pancreatitis who may be considered for outpatient management with significant cost-savings. Materials and Methods: This prospective observational study included 180 patients with mild AP according to the harmless acute pancreatitis score (HAPS) and Imrie score. The relationships of biochemical parameters with the changes in the Balthazar score and clinical course were examined. Results: The study included 180 patients (111 females, 69 males; mean age: 53.9 ± 17.2 years; range: 17–92 years). The etiology was biliary in 118 (65%) patients and remained undetermined in 38 (21.1%) patients. Computed tomography (CT) performed within the first 12 h revealed mild and moderate AP in 159 (88.3%) and 21 (11.7%) patients, respectively. CT repeated at 72 h revealed mild, moderate, and severe AP in 155 (86.1%), 24 (13.3%), and 1 (0.6%) patients, respectively. Comparisons between stages A + B + C and D + E showed significant differences in the amylase levels on day 1 and 3, and in C-reactive protein on day 3. Also, in stage D and E disease, narcotic analgesic intake, oral intake onset time, and pain were significantly higher. Conclusion: There were no significant changes in the CT findings of patients with mild AP at 12 and 72 h. Most patients (n = 179; 99.4%) recovered uneventfully. Patients with mild pancreatitis according to the HAPS and Imrie scores can be considered for outpatient management. The recovery is longer in stage D and E disease

Experience of the Endoscopists Matters in Endoscopic Retrograde Cholangiopancreatography in Billroth II Gastrectomy Patients

Conclusions: FRCP in patients who had undergone Billroth II gastrectomy was time consuming for the inexperienced endoscopist who should beware of the unique adverse events related to ERCP in patients with altered anatomy

Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions

Background/Aims: Despite the presence of many diagnostic methods, the differential diagnosis between benign and malignant biliary obstructions is still not easy. We aimed to evaluate the role of serum/biliary carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), vascular endothelial growth factor receptor-3(VEGFR-3), and total antioxidant capacity (TAC) tests in this differential diagnosis