Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Delta Hepatitine Bağlı Sirozlu Hastada Hepatosellüler Kanserin Yttrium-90 ile Radyoembolizasyon Tedavisi: Olgu Sunumu

Ülkemizde sirozun önemli etyolojik nedenlerinden biri delta hepatitidir. Hepatosellür kanser (HSK) sıklıkla siroz zemininde gelişmektedir. HSK tedavisinde radyoembolizasyon olarak adlandırılan yttrium-90 tedavisi son yıllarda gittikçe daha yaygın kullanılmaktadır. Radyoaktif mikropartiküllerin transarteryal olarak infüze edilmesinden oluşan ve daha yeni bir yöntem olan radyoembolizasyonun rezeke edilemeyen karaciğer tümörlerinde umut vaat ettiği bildirilmiştir. Delta hepatitine bağlı kompanse karaciğer sirozu zemininde HSK gelişen ve yttrium-90 ile başarılı kemoembolizasyonu yapılan 55 yaşında erkek hasta sunulmuştur.Cirrhosis due to delta hepatitis is one of the most important etiologic factors in our country. Hepatocellular carcinoma (HCC) often develops on the base of cirrhosis. Recently, yttrium-90 radioembolization therapy has been increasingly used in the treatment of HCC. Transarterial infusion of yttrium-90 radioactive microspheres is a new promising method in treating unresectable liver tumors. Herein, we present a 55-year-old male HCC patient who developed HCC due cirrhosis associated with delta hepatitis and was successfully treated with yttrium-90 radioembolization therapy

Two cases with liver cirrhosis secondary to hepatitis B that presented with hepatocellular carcinoma at young age

Abstract: Hepatocellular carcinoma (HCC) is the mostcommon primary malignant tumor of the liver. In men, themost common fifth in women the most common seventhtumor. Africa and Asia were more associated with hepatitisB virus, Europe and the United States is associated withhepatitis C virus. Underdeveloped countries dependingon an early age exposure to hepatitis viruses can also beseen in under 45 years, the incidence of HCC increasesafter the age of 45 at developed countries. They’re both36 years old, the son of aunt both patients were admittedwith complaints of abdominal bloating, and fatigue. In examinationrevealed splenomegaly and grade 1-2 acid. Intwo patients with HCC due to hepatitis B-related liver cirrhosisthat was detected at the first examination who arepresented in order to remind the importance of follow-upthe inactive infection or chronic HBV infection .Key words: Hepatocellular cancer, cirrhosis of the liver,chronic hepatitis

Nonsirotik portal hipertansiyonlu hastada dev peritoneal kist hidatik ve albendazole bağlı aplastik anemi

Albendazol geniş spektrumlu antiparazitik bir ilaçtır. Yan etkilerinin minimal olduğu bildirilmiştir. Hepatik, splenik ve peritoneal ekinokokkal kist nedeniyle albendazol başlanan, ikinci haftada febril nötropeni gelişen bir vaka sunulmuştur. 49 yaşında erkek hasta karında büyük kistik kitleleri nedeniyle müracaat etti. Hastanın hikayesinde nonsirotik portal hipertansiyon ve tekrarlayan kolanjit atakları dikkat çekmekte idi. Albendazol sulfoksit peak dozu ve yarılanma ömrü karaciğer hastalı klarında ve başka ilaçlar kullanıldığında artmaktadır. Bu vakada ciddi nötropeni gelişmiş olmasının altta yatan karaciğer hastalığına bağlı olduğu düşünülmüştür. Albendazol başlanacak bu tür hastalar kemik iliği toksisitesi yönünden sık kan sayımları ile yakından takip edilmeli, verilecek diğer ilaçlara dikkat edilmelidir.Albendazole has broad-spectrum coverage as an antiparasitic drug, and the reported side effects have been minimal. We report the case of a patient with febrile neutropenia beginning during the second week of therapy for a hepatic, splenic and peritoneal echinococcal cyst. This case was a 49-year-old man who presented with a large cystic abdominal mass. His medical history was significant for non-cirrhotic portal hypertension and recurrent cholangitis. Albendazole sulfoxide peak dose and half-life are significantly prolonged by liver disease and concomitant administration of certain drugs. The severity and duration of albendazole-induced neutropenia in this case was likely related to the underlying liver disease. Frequent serial monitoring of blood counts and cessation of medication with any evidence of marrow toxicity in such patients are warranted

Kronik viral hepatitlerde ekstrahepatik bulgular: Günlük klinik pratikte unutulmaması gereken bir nokta

Giriş ve Amaç: Hepatit etkeni virüsler kronik karaciğer hastalıklarına yol açmanın yanısıra ekstrahepatik bulgular olarak adlandırılan diğer organ ve dokularda da bozukluklara neden olabilirler. Tedavide ekstrahepatik tutulumları da gözardı etmemek gereklidir. Gereç ve Yöntem: stanbul Tıp Fakültesi Gastroenteroloji Bilim Dalında 1997-2010 yılları arasında takipli toplam 2870 hastada klinik olarak semptomatik ekstrahepatik tutulumu olan 52 hastanın (%2) demografik özellikleri retrospektif olarak değerlendirildi. Bulgular: Elli iki hastadan 27si (%52) hepatit C, 24ü (%46) hepatit B ve 1 (%2) hasta da hem hepatit B hem de hepatit C idi. Bunlardan 25i (%48) erkekti, ortalama yaş 5113 (18-78) yıldı. Otuz iki hasta (%61) sirotik evrede, 20 hasta (%39) ise presirotik evrede idi. Sonuç: Ekstrahepatik tutulumlar genelliklatlanmaktadır. Klinisyenler ekstrahepatik bulguların tanısında daha duyarlı olmalıdırlar.Background and Aims: Hepatitis viruses induce not only chronic liver diseases but also the impairment of other organs and tissues as extrahepatic manifestations. It is necessary to consider possible complications associated with extrahepatic diseases in the treatment. Materials and Methods: We retrospectively evaluated the demographic features of 52 (2%) patients who had clinically symptomatic extrahepatic manifestations from among 2870 chronic viral hepatitis patients in the Gastroenterology Department of the Istanbul Medical Faculty between 1997 and 2010. Results: Twenty-seven of the 52 patients (52%) had hepatitis C, 24 (46%) hepatitis B, and 1 (2%) both hepatitis B and C. Of these, 25 (48%) were males, and the mean age was 51±13 (range, 18 to 78) years. Thirty-two patients (61%) were cirrhotic, while 20 (39%) were in the precirrhotic stage. Conclusions: Extrahepatic involvement is generally overlooked, and clinicians should be more sensitive to the diagnoses of these manifestations

Özefagusun Parabronşiyal Divertikülü: Vaka Sunumu

WOS: 000376565500040Parabronşiyal ya da midözefagiyal divertiküller, özefagusun orta kesiminin periözefagiyal alana doğru kese şeklinde büyümesi sonucu ortaya çıkar. Bu büyüme genellikle mediastinel inflamasyona sekonder olarak oluşur. Biz, midözefagiyal divertikülü olan yirmibir yaşında erkek hastayı sunuyoruz. Literatür bilgileri eşliğinde bu özefagiyal patolojiyi tartışmayı amaçladık.Parabronchial or midesophageal diverticulum is a saclike bulging of the midesophageal wall into the periesophageal space. This bulging usually occur secondary to mediastinal inflammation. We report a case of a midesophageal diverticulum in a 21-year-old man. We discuss midesophageal diverticulum and review the literature findings

Gastroenterolojide yirmi yılda tanısal laparoskopinin rolü değişti mi? ,

Giriş ve Amaç: Girişimsel olmayan görüntüleme metotlarındaki ge - lişmeler sonrasında tanısal laparoskopinin kullanımı azalmıştır. Biz de gastroenteroloji ünitemizde tanısal laparoskopi olgularını inceledik. Gereç ve Yöntem: 1989-2010 yılları arasında İstanbul Tıp Fakültesi Gastroenteroloji Bilim Dalında laparoskopik işleme giren 1484 hasta - nın raporları retrospektif olarak değerlendirildi. Laparoskopi işlemi lokal anestezi altında Storz marka laparoskopi cihazı ile yapıldı. Bulgular: Asitli hastalar serum-asit albumin farklarına göre 1,1 g/dL ve 1,1 g/dL olacak şekilde iki gruba ayırılarak incelendi. Toplamda 93 (%6,3) hastanın tanısı laparoskopik inceleme sonrası değişti. Son beş yılda ek- suda asit ve peritoneal hastalık için yapılan tanısal laparoskopi sayısı azalmış olsa da bu azalma transuda asitlilerle karşılaştırıldığında azalma oranının daha düşük olduğu görülmektedir. Sonuç: Tanısal laparoskopi halen peritoneal tüberküloz tanısını koymada ve diğer malign hastalık- ların ayırıcı tanısında tercih edilen bir yöntemdir.Background and Aims: The use of diagnostic laparoscopy seems to have markedly reduced since the advent of major developments in noninvasive imaging modalities. We aimed to investigate the role of diagnostic laparoscopy in our gastroenterology unit. Materials and Methods: Reports of 1484 laparoscopy patients seen in the Gas- troenterology Department of Istanbul University, Istanbul Faculty of Medicine between 1989 and 2010 were evaluated retrospectively. Laparoscopy was performed using the Storz laparoscope under local anesthesia. Results: Patients with ascites were evaluated in two differ- ent groups according to serum-ascites albumin gradient values as >1.1 g/dL and <1,1 g/dL. Diagnoses of 93 (6,3%) patients were revised af- ter the laparoscopic examination. Although diagnostic laparoscopy for evaluation of exudative ascites and peritoneal disease has decreased in the last quarter, the decrease was relatively less when compared with that for transudative ascites. Conclusions: Diagnostic laparoscopy is still the preferred method both for the diagnosis of peritoneal tubercu - losis and to rule out other diseases such as malignancy

Presentation with hepatic mass and ERCP extraction of Fasciola hepatica: A case report and review of the literature

Fasciola hepatica infeksiyonu ülkemizin bazı bölgelerinde endemik olarak rastlanan bir karaciğer trematodudur. Klinik bulgular nonspesifik olup; karın ağrısı, sağ üst kadranda hassasiyet şeklinde olabilir. Laboratuvarda eozinofi- li, karaciğer enzimlerinin yükselmesi, pozitif seroloji görülür. Görüntüleme yöntemlerinde karaciğerde çok sayıda nodüller ve safra yollarında dilatasyon görülür. Triclabendazol hepatik ve biliyer fazda etkilidir. Endoskopik retrog- rad kolanjiopankreatografi ile canlı Fasciola hepaticaların biliyer kanaldan uzaklaştırılması ile de tedavi edilir. Burada karaciğerde kitle nedeniyle tetkik edilen, safra yollarında dilatasyona neden olan ve endoskopik retrograd ko- lanjiopankreatografi ile tedavi edilen fasciola hepaticalı genç bayan olgusu sunulmuştur.Fasciola hepatica is a liver trematode that is endemic in some parts of Turkey. Clinical findings are nonspecific, such as abdominal pain and right upper quadrant tenderness. Eosinophilia, elevated liver enzymes and positive se- rology can be detected in laboratory investigations, while multiple nodules in the liver and dilated bile ducts can be seen in imaging modalities. Tricla- bendazole is effective in the hepatic and biliary phases. Fasciola hepatica is also treated with endoscopic retrograde cholangiopancreatography by biliary duct removal. Herein, we present a young woman who was evaluated with a mass in the liver and biliary tract dilatation caused by Fasciola hepatica and who was treated with endoscopic retrograde cholangiopancreatography