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Background Data comparing their long-term efficacy and safety of Infliximab (IFX) and adalimumab (ADA) in moderate to severe ulcerative colitis (UC) is limited. In this study we aimed to compare the long-term effectiveness and safety of IFX and ADA in UC who had not previously received biologic therapy. Methods: Data from patients treated between 2007 and 2021 was collected and analyzed. Outcomes evaluated included UC-related hospitalization, colectomy, steroid use, and serious infections leading to treatment cessation. Results Of 86 UC patients, 41 received IFX and 45 received ADA. No differences were found in terms of demographics, risk factors, baseline Mayo scores and treatment history. During anti-TNF therapy, steroid use was significantly higher in the ADA group (44.4%) compared to the IFX group (14.6%). UC-related hospitalization and colectomy rates were similar between the two groups, as were rates of serious infection leading to treatment cessation. These outcomes were similar in UC patients treated with IFX or ADA monotherapy or in combination with an immunomodulator. The Kaplan-Meier analysis showed that the duration of discontinuation of the drug due to secondary loss of response was longer in the IFX group compared ADA the other group, although the difference was not statistically significant (72.5% versus 46.7%, p = 0.057). Conclusion Overall, the study suggests that IFX and ADA may be similar in terms of clinical outcomes for UC patients who are new users of anti-TNF agents, but the higher rate of steroid use in the ADA group should be noted.

Amaç: Bu çalışmamızda hastanede yatan hafif Covid-19 enfeksiyonu olan hastalarda gastrointestinal (GI) semptomların klinik önemini belirlemeyi amaçladık.Materyal ve Metod: Bu çalışma, doğrulanmış bir Covid-19 enfeksiyonu teşhisi ile hastaneye yatırılan yetişkin hastaları içermektedir. Demografik özellikler, semptomlar, klinik tablolar, tıbbi öykü, ilaçlar ve klinik ilerleme ve sonuçlar klinisyenler tarafından veri toplama formu kullanılarak not edildi. Hafif Covid-19 enfeksiyonu olan hastalarda GI semptomlarının klinik sonuçlara etkisi istatistiksel olarak değerlendirildi.Bulgular: 307 hasta çalışmaya dahil edildi. Hastaların 159'unda (%51,7) en az bir GI semptomu vardı. Hastaların %18.2'si sadece GI semptomları, %21,2'si ise sadece GI dışı semptomlar gösterdi. Hastaların %27'si başvuru sırasında asemptomatikti. En sık görülen GI semptom hastaların %16.9'unda görülen iştahsızlıktı. En sık görülen ikinci ve üçüncü GI semptomları sırasıyla %15 hastada ishal, %14 hastada bulantı ve tat kaybıydı. GI ve GI olmayan semptom grupları arasında laboratuvar parametrelerinde anlamlı bir fark yoktu. GI ve GI olmayan semptom grupları olan hastaların yaş, cinsiyet, sigara içme durumu ve komorbiditeleri karşılaştırıldığında, ortalama yaş, cinsiyet, sigara içenler ve komorbiditeler açısından fark yoktu. Ayrıca hastanede kalış süresi (p=0,377), tam iyileşme (p=0,372) ve mortalite (p=0,351) GI ve GI olmayan semptom gruplarında sırasıyla benzerdi.Sonuç: GI semptomlarıyla kendini gösteren Covid-19 enfeksiyonunun erken teşhisi, enfeksiyonun yayılmasını önlemeye yardımcı olabilir. Hastalarda saptanan GI semptomların çoğu hafif olup bunların varlığı daha kötü klinik sonuçlarla ilişkili saptanmamıştır., Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection. Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated. Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively. Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.

ÖZETİnflamatuvar barsak hastalıkları aktivasyon ve remisyon ile giden ve etiyolojisi bilinmeyen kronik intestinal hastalıklardır. Aktiviteyi belirlemek inflamatuvar barsak hastalığında tedavinin düzenlenmesi ve prognozu göstermesi açısından büyük önem taşır. Aktiviteyi belirlemek için halen ortak bir konsensüs oluşmamıştır. Reelin de nörolojik gelişim ve sinaptik plastisite önemli roller oynamaktadır. Reelinin şizofreni patogenezinde rolü bulunmaktadır.Araştırma Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Gastroenteroloji – İBH Polikliniği’nde gerçekleştirilmiştir. Takip ve tedavisi yapılan İBH vakası 194 hasta ve 30 sağlıklı kontrol dâhil edilmiştir. Hastaların verileri poliklinik dosya ve hastane bilgi işlem sisteminden elde edilmiştir. CH aktivite indeksi ile UC True Love aktivite indeksi kullanılmış ve serumda Reelin düzeyi çalışılmıştır. Çalışma retrospektif olup hastalara ek herhangi bir işlem uygulanmamıştır.Araştırmada da; Reelin düzeyleri ÜK total: 0,6216 +/- 1,0835 aktif:0,3846 +/- 0,4850 remisyon:0,4354 +/- 0,4354 idi. CD’da Reelin total:0,3993 +/-0,5101 aktif: 0,3675 +/- 0,5789 remisyon: 0,4354 +/- 0,5789 idi ve kontrol grubunda: 0,5576 +/- 0,6142 olarak saptandı. ÜK ve CH arasında serum Reelin düzeyi ile anlamlı fark saptanmamış, ÜK ve CH ile ayrı ayrı kontrol grubu ile olan karşılaştırma sonucu anlamlı fark bulunmamıştır. (p > 0,05). Bu bağlamda da görülmektedir ki, serum Reelin düzeyinin ÜK ve CH vakalarını etkileme düzeyi farklılık içermemektedir. Araştırma kapsamında, ÜK ve CH aktif ve kontrol grubu arasında istatistik bakımdan anlamlı bulunmamıştır (p > 0,05). ÜK reelin düzeyleri:0,6216 +/- 1,0835 (X2 = 0,109; p > 0,05) ve aktif ÜK reelin düzeyleri: 0,3846 +/- 0,4850 (X2 = 0,820; p > 0,05) tutulum görülen lokasyona göre anlamlı farklılık göstermemektedir.Gruplar bazında genel olarak değerlendirildiğinde de görülmektedir ki, Reelin düzeyleri tutulum görülen lokasyona göre anlamlı farklılık göstermemektedir (X2 = 1,007; p> 0,05). Sonuç olarak çalışmamız; Reelinin, İBH’da aktivasyon remisyon markerı olarak kullanılamayacağını ve ayrıca ÜK-Crohn arasında ayrıcı tanıda belirteç olmadığını göstermektedir, Background/Aim: Crohn's Disease (CD) and Ulcerative Colitis (UC) are grouped as Inflammatory Bowel Diseases (IBD). There are many similarities between these two diseases, and CD and UC cases cannot be separated at a rate varying between 5% and 10%. Reelin is an extracellular matrix protein first known for its vital role in neuronal migration. Studies in rodent small intestine suggested that reelin protects the organism from intestinal pathologies. In a 5-year retrospective case-control study, we aimed to detect the effectiveness of serum reelin level in patients with IBD in determining the severity and activation of the disease and compare healthy volunteers with patients in terms of inactivation and remission.Methods: The data of all 194 IBD patients diagnosed at Beyazit Training and Research Hospital between 2011-2015 were retrospectively reviewed. The patients were matched with 30 healthy volunteers. Risk factors were assessed by multivariate logistic regression analysis.Results: The serum reelin levels were similar between UC and CD patients, the control group, UC and CD groups (P=0.067), and those with active disease or disease in remission, and did not differ according to disease behavior or location of involvement. Conclusions: Our study shows that Reelin cannot be used as an activation/remission marker in IBD. In addition, it does not differentiate between UC and CD.

Background The comparative efficacy and safety of infliximab (IFX) and adalimumab (ADA) have shown variable results in biologic-naïve patients with Crohn’s disease (CD). Thus, long-term comparisons between IFX and ADA with or without immunomodulator therapies are still needed. The purpose of this study was to evaluate the long-term clinical effectiveness and safety profile of IFX compared to ADA in biologic-naïve patients with CD. Methods Data of all adult CD patients treated with IFX or ADA as their first biologic agent was collected retrospectively between December 2007 and February 2021. We compared CD-related hospitalization, CD-related major abdominal surgery, steroid use and serious infections leading to treatment cessation. Results Out of 224 biologic-naïve patients with CD, 101 started IFX first (median age at onset: 38.12 years, 61.4% male) and 123 started ADA first (median age at onset: 30.2 years, 64.2% male). Median disease duration was 6.94 years (IQR: 3.82–12.17) and 6.91 years (IQR: 3.94–10.95) for IFX and ADA, respectively, of whom 33% and 37.4% had active smokers, 10.9% and 13.4% had family history of inflammatory bowel disease (IBD) 22.8% and 19.5% had perianal disease, 43.6% and 43.9 had prior major abdominal surgery and 52.6% and 49.6% had extraintestinal manifestations. There were no significant differences between the two groups with respect to the age at onset of tumor necrosis factor antagonist, gender, smoking status, family history of IBD, perianal disease, prior major abdominal surgery, extraintestinal manifestations, prior immunomodulator (Thiopurine or Methotrexate) or steroid usage, all laboratory test results and Crohn’s Disease Activity Index (CDAI) score at baseline (p>0.05). Overall, the median follow-up time was 2.81 and 3.55 years after starting the first IFX and ADA group, respectively. There were no significant differences in the rate of steroid use (4% IFX vs. 10.6% ADA p=0.109), CD-related hospitalization (13.9% IFX vs. 22.8% ADA p=0.127), CD-related major abdominal surgery (9.9% IFX vs. 13% ADA p=0.608) and serious infections leading to treatment cessation (1% IFX vs 0.8% ADA p>0.999) between IFX and ADA. These outcomes were similar in patients treated with IFX or ADA monotherapy or in combination with an immunomodulator. Conclusion In this retrospective observational tertiary referral center study, we observed that there was no significant difference in long-term effectiveness and safety of infliximab and adalimumab in biologic-naïve patients with CD.

Background Crohn’s disease (CD) and Familial Mediterranean fever (FMF) are both inflammatory disorders characterised by recurrent abdominal pain and fever attacks. Mutations of Mediterranean (MEFV) gene appear to be associated with stricturing behaviour and extraintestinal manifestations of CD. Further clinical studies regarding progression of CD in coexistence with FMF is still required. The aim of this study was to evaluate the influence of concomitant FMF in CD patients on the course of the CD in FMF endemic area. Methods Total 210 adult patients who had diagnosed with CD with or without FMF between November 2006 and April 2019 were respectively examined. FMF diagnoses were based on Tel-Hashomer criteria. The Montreal classification was used to define location and behaviour of CD. CD patients were divided into two groups FMF positive and FMF negative. Severity of CD was assessed by the need for hospitalisation related to CD, whether biological therapy was received and/or whether surgery was undergone due to CD. All demographic features, MEFV mutations, location/behaviour of disease, and extraintestinal manifestations were analysed retrospectively. Results In the present study, 8 (3.8%) of the total 210 CD patients have concomitant FMF. Mean follow-up time in CD-FMF was 59.55 months and CD-non-FMF was 60.98 months. CD patients with or without FMF showed similar demographic features including age, sex, smoking behaviour, disease location, behaviour, and treatment regimen in maintenance of the remission. Regarding extraintestinal manifestations, only peripheral arthritis was found significantly higher in CD-FMF patients (n = 3, 37.5%) compared CD-non-FMF patients (n = 21, 10.4%). In the CD-FMF patients, a result of MEFV mutation gene analysis was found in medical records 6 patients. Of those, 2 had homozygote MEFV mutation, 2 had heterozygote MEFV mutation and 2 without any MEFV mutations. In CD-FMF group, percentage of patients on biological therapy (n = 4, 50%) was significantly higher than CD-non FMF group (n = 24, 11.9%) (p = 0.012). Steroid dependence and hospitalisation in CD-FMF (n = 3, 37.5% and n = 5, 62.5%) group were relatively higher than CD-non-FMF (n = 83, 41.1%) group, but not statistically significant. The percentage of CD-FMF patients who underwent intestinal surgery (n = 1, 12.5%) was similar to that of CD-non-FMF (n = 33, 16.3%). Conclusion In the current study, the prevalence of FMF in CD patients was detected 3.8% in FMF endemic area. The group of patients on biological therapy in CD-FMF patients was significantly higher than CD-non-FMF patients. Frequency of hospitalisation in CD-FMF patients was relatively higher than CD-non-FMF patients. Our findings indicate that concomitant FMF in CD patients may have a negative effect on the course of CD.

Pantoprazole is a proton pump inhibitor that is commonly used in the treatment of peptic ulcer disease (PUD) and metabolized by cytochrome P450 (CYP) enzymes CYP2C19 and CYP3A4. Pantoprazole is a substrate for multi-drug resistance protein 1 (MDR1). Single nucleotide polymorphisms (SNPs) in CYP2C19, CYP3A4 and MDR1 affect enzyme activity or gene expression of proteins and may alter plasma pantoprazole concentrations and treatment success in PUD. In this study, we aimed to investigate the association between genetic polymorphisms in CYP2C19, CYP3A4 and MDR1 and pharmacokinetics of pantoprazole and therapeutic outcome in patients with either Helicobacter pylori-associated [H.P.(+)]-PUD or [H.P.(+)]-gastritis. The plasma pantoprazole concentrations were determined by using an HPLC method at the third hour after a 40-mg tablet of pantoprazole administration in 194 newly diagnosed patients with either [H.P.(+)]-PUD or [H.P.(+)]-gastritis. Genotyping was performed by using PCR-RFLP and DNA sequencing. Among patients appearing for follow-up examination (n = 105), the eradication rate for H. pylori was 82.8% (n = 87). The median pantoprazole plasma concentrations in poor metabolizers (PM), rapid metabolizers (RM) and ultrarapid metabolizers (URM) were 2.07, 1.69 and 1.28 μg/ml, respectively (p = 0.04). CYP3A4*1G and *22 polymorphisms did not affect plasma pantoprazole concentrations and H. pylori eradication rate. The MDR1 genetic polymorphisms did not affect plasma pantoprazole concentrations. MDR1 3435CC-2677GG-1236CC haplotype carriers had lower H. pylori eradication rate (60%) than the remaining subjects (84.9%) while the difference was not statistically significant (p = 0.07). In conclusion, while CYP2C19 genetic polymorphisms significantly affected plasma pantoprazole concentrations, polymorphisms of CYP2C19, CYP3A4 and MDR1 did not affect H. pylori eradication rates.

Background/aims To evaluate the effectiveness of tenofovir in patients with chronic hepatitis B infection in a real life setting. Materials and methods We performed a retrospective analysis of data from 164 patients with chronic hepatitis B who were treated with Tenofovir. Eighty-six patients (52.4%) were naive. Seventy-seven (46.9%) patients were previously treated with anti-viral drugs, including standard interferon (n=4), pegylated (PEG) interferon (n=14), standard interferon together with lamivudine (n=13), lamivudine alone (n=41), adefovir (n=2), lamivudine together with adefovir (n=1), and entecavir (n=2). Six patients (3.7%) had liver cirrhosis before treatment of tenofovir. Results The patients who have hepatitis B viral DNA>104 copy/mL with chronic hepatitis B infection were included in the treatment of Tenofovir. Average follow up time was 30.31±14.33 months. HBV DNA negativity and alanine aminotransferase (ALT) normalization were 86.5% and 71.3%, respectively, at the last visit. Hepatitis B e-Antigen (HBeAg) seroconversion occurred in 11 (19.6%) out of 164 patients. During the follow-up period, 4 (2.4%) patients developed liver cirrhosis and in 5 (3%) patients hepatocellular carcinoma (HCC) occurred out of 164 patients. HBsAg seroconversion occurred in one patient (0.6%). Conclusion Tenofovir can be used safely and successfully in those patients that were naive, experienced with immune modulators and/or antivirals, HBeAg-positive, and HBeAg-negative patients.

Background: Mannose binding lectin (MBL) is believed to be an important component of the innate immune response. MBL may be an important non-invasive predictor for progression of hepatitis B virus infection. In this study, we examined whether there is a relationship between MBL levels and progression of hepatitis B virus infection. Methods: In this cross-sectional study, fifty patients with chronic hepatitis B and 21healthy control subjects were included. They were classified into three groups: Active hepatitis B, inactive hepatitis B and healthy control groups. The association between MBL level with the stage of fibrosis and histological activity index (HAI) was found in patients with active chronic hepatitis B. Results: The mean ± SD of MBL level was as 2875.3 ± 2040.03 ng/ml in active HBV patients, 2463.9 ± 1915.4 ng / ml in inactive HBV patients, and 1865.04 ± 265.6 ng/ml in healthy controls (P: 0.344). MBL was not significantly correlated with HAI and the stage of fibrosis (r: -0.30, P: 0.876 and r: 0.077, P: 0.687, respectively). Conclusion: In our study, we could not find any significant association between MBL levels and progression of HBV infection; which is not in line with the hypothesis that MBL may be beneficial as a non-invasive predictor of the survival of patients with hepatitis B virus infection.

Background: Cancer antigen 125 (CA‐125) is a tumor marker used for the diagnosis and monitoring of ovarian carcinoma. It can also be elevated in endometriosis, inflammations, and in nongynecological malignancies. Up to date, serum CA‐125 levels in inflammatory bowel diseases (IBD) have not been studied before. Aim: To assess the levels of CA‐125 in patients with ulcerative colitis (UC) and Crohn's disease (CD). Methods: Serum levels of CA‐125 were investigated in 68 cases with UC (male/female: 47/21), 32 CD (male/female: 21/11), and 31 healthy controls (male/female: 16/15). Levels of CA‐125 were also compared among UC patients according to lesion location, severity, and activity of CD. Results: Serum CA‐125 levels were 17.29±24.50 U/ml, 15.56±20.74 U/ml, and 8.85±2.62 U/ml in patients with UC, CD, and healthy controls, respectively. Serum CA‐125 levels were significantly higher in UC compared to control group (P=0.001). Serum CA‐125 levels were higher in CD patients compared to control group but there was no significance (P=0.087). Serum CA‐125 levels were higher in pancolitis compared to distal type and left‐sided UC. Conclusions: Our data suggest that serum CA‐125 levels may be increased in patients with IBDs. J. Clin. Lab. Anal. 23:244–248, 2009. © 2009 Wiley‐Liss, Inc.

A 62-year-old woman was evaluated for iron deficiency anemia. She had no history of any medications, trauma, smoking, or alcohol consumption. On physical examination, the patient had a pale appearance, and tenderness in the epigastric region but no rigidity or rebound. Upper gastrointestinal endoscopy revealed the majority of the stomach and duodenal bulb to be normal. However, a well-hidden, red-colored, ulcerated lesion (diameter 2cm) was observed. The lesion was located mainly on the posterior side of the duodenal bulb, partly occupying the duodenal bulb, and extended to the descending duodenum (●" Fig.1 and●" Video 1). The appearance and size of the lesion suggested a gastrointestinal stromal tumor (GIST), and it was therefore removed surgically. Histopathological examination of the resected tissue confirmed GIST. The patient was discharged 3 days after the surgery, and was doing well at follow-up. GISTs are the most common submucosal tumors of the gastrointestinal tract, representing 1%–3% of gastrointestinal malignancies. About 50%–60% of GISTs occur in the stomach, and about 20%–30% are malignant [1]. The duodenum is an uncommon location. Diagnosis of duodenal GIST is sometimes difficult, especially those arising in the posterior duodenal bulb. As peristalsis allows a better view of the duodenal bulb mucosa, observation of this area for a while during endoscopic examination is a feasiblemethodofdetecting hidden lesions.

A 51-year-old woman with an 8-month history of recurrent episodes of abdominal pain, mild bloody diarrhea, andweight loss (6kg in 3 months) was referred to our unit for evaluation of suspected Crohn’s disease. She had carried a diagnosis of type 1 neurofibromatosis for 30 years. Physical examination revealed multiple cafe-au-lait spots and multiple cutaneous neurofibromas. Her abdomen was mildly tender in the lower abdomen with no detectable palpable mass. Laboratory test results were as follows: hemoglobin level 9.6g/dL, sedimentation rate 40mm/h, C-reactive protein 23mg/dL. Other biochemical tests were unremarkable. A colonoscopy revealed a normal-appearing colon and an edematous terminal ileum with a 1-cm pedunculated polyp covered by exudate (●" Fig.1). A magnetic resonance enterography showed thickening of the jejunum and terminal ileum, and a pedunculated polyp, about 1cm in diameter, located in the terminal ileum (●" Fig. 2). An oral double-balloon enteroscopy showed multiple, raspberry-like, 3–5mm, sessile polyps, which were covered by faint exudates located in the proximal jejunum (●" Fig.3). Biopsies of the polyps in the jejunum and ileum revealed intestinal ganglioneuromatosis. Type 1 neurofibromatosis, also known as von Recklinghausen disease, may affect the gastrointestinal tract in 25% of patients in whom intestinal neurofibromas, gastrointestinal stromal tumors, or ganglioneuromatosis can be detected [1,2]. Intestinal ganglioneuromatosis is a rare neoplastic condition characterized by proliferation of nerve ganglion cells, nerve fibers, and supporting cells of the enteric nervous system. It occurs in three forms: as an isolated polyp, as multiple polyps (ganglioneuromatous polyposis), and as diffuse involvement of the bowel wall (diffuse intestinal ganglioneuromatosis) [1]. The disease may affect any part of the gastrointestinal tract. The most common symptoms are abdominal pain, change in bowel habit, diarrhea, and gastrointestinal bleeding, which resemble Crohn’s disease.

Spontan dalak infarkt› siroz ve portal hipertansiyonda nadiren gorulmektedir. Klinik gorunumu akut kar›n ar›s›n› taklit edebi- lir. Bu durumun tan›s› klinik bulgular ve dala¤›n goruntulenmesi ile konur. Son y›llarda, ultrasonografi ve bilgisayarl› tomogra- fi dalak enfarkt› tan›s› icin popularite kazanm›flt›r. Cok say›da olguda infarkt bolgeseldir ve tedavi counlukla konservatiftir. Biz burada siroza bal› portal hipertansiyon ve ayn› zamanda komorbiditeleri bulunan yafll› sirotik bir olguda nadir gorulen spontan dalak infarkt›n› bildiriyoruz. 72 yafl›nda sirozu olan kad›n hasta, iki gundur devam eden kar›n sol ust kadran ar›s› nedeni ile baflvurdu. Ozgecmiflinde kriptojenik siroz, konjestif kalp yetmezlii, kronik obstruktif akcier hastal›¤› ve hipertansiyon oykusu var- d›. Fizik muayenesinde palpasyonla splenomegali vard›. Bat›n ultrasonografisinde splenomegali ve dalak orta bolumde subkapsu- ler alandan hilusa doru uzanan 62x35 mm cap›nda lobule konturlu hipoekoik alan izlendi. Bat›n tomografisinde dalakta 64x58 mm cap›nda subkapsuler hipodens lezyon goruldu. Doppler ultrasonografide dalak hilusundan lateral zona doru uzanan kama fleklinde heterojen hipoekoik avaskuler alan saptand›. Olgumuzda bilgisayarl› tomografi ve Doppler ultrason ile dalak infarkt› ta- n›s› kondu. Hastam›zda altta yatan hastal›klar›n konservatif tedavisi yap›ld›. Spontan dalak enfarkt› sol ust kadran ar›s› ile bafl- vuran ve komorbiditeleri bulunan sirozlu hastalarda goz onunde bulundurulmal›d›r. Anahtar kelimeler: Dalak infarkt›, siroz, portal hipertansiyon Spontaneous splenic infarction has been seen rarely in cirrhosis and portal hypertension. The clinical presentation can mimic other causes of acute abdominal pain. The diagnosis of the condition is based on clinical findings and splenic imaging. In recent years, ultrasonography and computed tomographic scan have gained in popularity for the diagnosis of splenic infarction. Most reported cases are of focal infarction, and treatment is mostly conservative. Herein, we describe a rare case of spontaneous splenic infarction in an elderly cirrhotic patient with portal hypertension who also had comorbidities. A 72-year-old female previously diagnosed with cirrhosis was admitted for left upper quadrant abdominal pain for two days. Her medical history included cryptogenic cirrhosis, congestive heart failure, chronic obstructive pulmonary disease, and hypertension. Physical examination on admission revealed a palpable splenomegaly. Abdominal ultrasonography revealed splenomegaly and a hypoechoic area with lobulated contours mea- suring 62x35 mm extending from the subcapsular area to the hilus in the middle section of the spleen. Abdominal computed tomo- graphic showed a subcapsular hypodense lesion of the spleen measuring 64x58 mm. Doppler ultrasound revealed a wedge-shaped heterogeneous hypoechoic avascular area extending from the central zone to the lateral zone of the spleen. In our case, diagnosis of splenic infarction was made by computed tomographic and Doppler ultrasonography. Our patient received conservative treatment for the underlying diseases. Spontaneous splenic infarction must be kept in mind in cirrhotic patients with underlying comorbidi- ties presenting with left upper quadrant pain.

Colorectal cancer (CRC) is the third most common cause of cancer-related death in Europe. The aim of the present study was to elucidate the efficiency of the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and the mean platelet volume (MPV) as tools for the preoperative diagnosis of CRC and their usefulness in the follow-up of CRC. A total of 144 CRC patients, as diagnosed by colonoscopy, and 143 age-matched and sex-matched healthy participants were included in the study. Medical records were used to compare preoperative and postoperative data including hemoglobin levels, platelet counts, MPV, NLR, and PLR. NLR, PLR, and MPV were significantly higher in CRC patients preoperatively, compared with healthy participants. Receiver-operating characteristic curve analysis suggested 2.02 as the cutoff value for NLR [area under the curve (AUC): 0.921, sensitivity: 86%, specificity: 84%], 135 as the cutoff value for PLR, (AUC: 0.853, sensitivity: 70%, specificity: 90%) and 8.25 fl as the cutoff value for MPV (AUC: 0.717, sensitivity: 54%, specificity: 76%). Subgroup analysis showed that NLR, PLR, and MPV levels were also significantly higher in nonanemic CRC patients compared with the control group, which is of great theoretical and clinical value for the early detection of CRC. Surgical tumor resection resulted in a significant decrease in NLR, PLR, and MPV. Our results suggest that NLR, PLR, and MPV may be used as easily available additional biomarkers for CRC in screening the general population, as well as in postoperative follow-up.

We read the study of Cheng et al. [1] with great interest and congratulate the authors on this excellent piece of work. The authors found that intravenous albumin transfusion strategy has beneficial effects in patients with gastrointestinal bleeding and hypoalbuminemia. In patients with advanced hypoalbuminemia and ascites, hypervolemia occurs as a result of a decrease in effective circulating volume (ECV), profound hypoalbuminemia and activation of the renin–angiotensin–aldosterone system [2]. The ensuing loss of blood due to acute upper gastrointestinal bleeding will tend to cause a further reduction of ECV. This situation will cause systemic vasoconstriction, renal blood flow and a decrease of the granular filtration fraction, as well as renal water reabsorption by over-activation of the renin–angiotensin–aldosterone system. Also, more aggressive transfusion therapy without colloid oncotic pressure extenders will be locked in a vicious cycle of hypervolemia and ascites, and increased risk of adverse events [3]. For these reasons, we agree with Dr. Cheng and colleagues that intravenous albumin transfusion strategy should be the main arm of therapy for management of advanced hypoalbuminemia.

Previous studies have focused on the relationship between halitosis, gastroesophageal reflux disease and Helicobacter pylori. In this study we aimed to investigate the interaction between halitosis and upper gastrointestinal endoscopic findings.Patients who previously had dyspepsia and had undergone endoscopic examination were included in the study. Symptoms of dyspepsia were investigated by means of a questionnaire that investigated halitosis. Patients who suffered from objective halitosis (confirmed by questions both to the patient and their relatives) were further investigated. Patients with known local or systemic causes of halitosis or structural disorders at endoscopy were excluded.The study included 358 patients (121 men and 237 women) with dyspeptic symptoms. The patients with and without halitosis had mean ages of (39.4 ± 13.5) and (43.1 ± 14.9) years, respectively. Patients without halitosis were significantly older than those in the halitosis group (P0.05). Patients in the halitosis group had significantly higher frequencies of regurgitation, bloating and nausea (P0.05) when compared to patients without halitosis. Endoscopic findings, including esophagitis, open cardia, hiatal hernia, gastritis and duodenitis, were comparable in the two groups.The frequency of halitosis was high in patients with dyspepsia who underwent upper gastrointestinal endoscopy. Halitosis had a close relationship with several upper gastrointestinal symptoms, including regurgitation, nausea and bloating. There was no significant association between upper gastrointestinal endoscopic findings and halitosis.

Biliary microhamartomas, also known as bile duct hamartomas and von Meyenburg complexes, are benign neoplasms containing cystic dilated bile ducts embedded in fibrous stroma. They develop in hepatobiliary system, do not generally give clinical outcomes, and are detected incidentally. However, they can rarely show malignant transformation. Our aim was to report the contribution of computed tomography, routine magnetic resonance imaging, and magnetic resonance cholangiopancreatography in the diagnosis of biliary microhamartomas in a 61-year-old woman.

Introduction: Many noninvasive tests have been studied for the diagnosis and determining the liver fibrosis score (LFS). In this study, we aimed to research the correlation of mean platelet volume (MPV) and stage of liver fibrosis in patients with chronic hepatitis B (CHB). Patients and Methods: Fifty-nine patients with CHB were enrolled retrospectively into the study. Age–sex matched 25 healthy subjects were used as control group. The following data were obtained from computerized patient registry database: HBV-DNA level, hepatitis B e-antigen seropositivity, liver enzymes and function tests, white blood cell count, platelet count, hemoglobin, histological activity index, LFS, and MPV. Patients were divided into two groups: patients without significant fibrosis (F0, F1, or F2) (Group 1) and patients with advanced fibrosis (F3, F4) (Group 2). Results: A statistically significant increase in MPV was seen in patients with CHB compared with healthy controls (8.49±0.84 fl vs.7.65±0.42 fl, P

Özet Metabolik sendrom obezite, dislipidemi, hiperglisemi ve hipertansiyon gibi hastalıkların toplamından oluşur. Metabolik sendrom bileşenlerinin çoğu tümör gelişimi ile bağlantılıdır. Metabolik sendrom ve visseral obezitenin genel populasyonda sıklık ve yaygınlığı giderek artmaktadır. Obezite son zamanlarda kanserlerin çoğunda mortalite ile bağlantılıdır. Kolorektal kanser önemli bir halk sağlığı problemidir. Son raporlar metabolik sendromlu bireylerde kolon veya rektum kanseri riskinin yüksek olduğunu göstermiştir. Metabolik sendrom ve kolorektal kanser arasındaki bağlantının patofizyolojik mekanizması çoğunlukla abdominal obezite ve insülin direnci ile ilişkilidir. Beslenme, egzersiz ve stresi azaltmayı kapsayan multidisipliner bir yaklaşım insülin direncini sınırlamada ve kanser sonuçlarını iyileştirmede çok önemli bir fırsat olabilir. Anahtar sözcükler: Metabolik sendrom, kanser, insülin direnci, obezite Abstract Metabolic syndrome consists of a cluster of diseases including obesity, dyslipidemia, hyperglycemia and hypertension. Most of the components of metabolic syndrome have been associated with the development of neoplasm. The metabolic syndrome and visceral obesity have an increasing prevalence and incidence in the general population. Obesity has recently been linked to mortality in the majority of cancers. Colorectal cancer is an important public health problem. Recent reports in individuals with metabolic syndrome showed a high risk of colon or rectal cancer. The pathophysiological mechanism that links metabolic syndrome and colorectal cancer is mostly related to abdominal obesity and insulin resistance. A multidisciplinary approach involving nutrition, exercise, and stress reduction may be an opportunity to limit the insulin-resistant state and improve cancer outcomes. Keywords: Metabolic syndrome, cancer, insulin resistance, obesity, Metabolik sendrom obezite, dislipidemi, hiperglisemi ve hipertansiyon gibi hastalıkların toplamından oluşur. Metabolik sendrom bileşenlerinin çoğu tümör gelişimi ile bağlantılıdır. Metabolik sendrom ve visseral obezitenin genel populasyonda sıklık ve yaygınlığı giderek artmaktadır. Obezite son zamanlarda kanserlerin çoğunda mortalite ile bağlantılıdır. Kolorektal kanser önemli bir halk sağlığı problemidir. Son raporlar metabolik sendromlu bireylerde kolon veya rektum kanseri riskinin yüksek olduğunu göstermiştir. Metabolik sendrom ve kolorektal kanser arasındaki bağlantının patofizyolojik mekanizması çoğunlukla abdominal obezite ve insülin direnci ile ilişkilidir. Beslenme, egzersiz ve stresi azaltmayı kapsayan multidisipliner bir yaklaşım insülin direncini sınırlamada ve kanser sonuçlarını iyileştirmede çok önemli bir fırsat olabilir

Amaç. HDV ile enfektia kronik hepatit hastalarımızın cilt altı interferon tedavisi sonrası takip sonuçlarını sunmak. Yöntem. Toplam 24 hastanın (21 Erkek, 3 Kadın) HBsAg (+), AntiHBc IgM (-), hepatit D virüsüne karşı antikor (anti HDV) ve/veya HDV RNA (+) ve karaciğer transaminazları normalden üst seviyedeydi. Bu hastaların tedavi için kontraendikasyonları yoktu hastaların uygun histolojik aktivite endeksleri ve karaciğer biyopsilerinde fibrozis skorları kaydedildi. Hastalar haftada 3 doz 9-10 MU cilt altı interferon ile tedavi edildi. Serumaminotransferzları HBsAg, anti HBs, HBeAg, anti HBeAg, HBV DNA, anti HDV ve/veya HDV RNA seviyeleri tedaviden önce tedavi esnasında ve sonrasında belirlendi. Bulgular. Dokuz hasta (%37,5) tedaviyi erkan safhada durdurdu. Üç hasta (%12,5) tedavi ciddi yan etkilerden dolayı bırakıldı. Tedavi sonrası dönemde HBV DNA’sı tüm hastalarda negatifdi. Oniki aylık tedaviyi tamamlayan 4 hastada (%33,3) ALT seviyeleri 3. ayda normal değerlere düştü ve 24 aylık takip süresince bu seviyeyi korudu; bir hastadan ALT seviyeleri hafifce arttı 6. ve 12. aylarında hafifce yükseldi sonrası kontrollerinde normal seviyelerine düştüğü görüldü. Sonuç. Anti viral etkinliği ve biyolojik aktivite spektrumu olan proinflamatuvar sitokin olan yüksek doz olan interferonun kronik hepaptit D’nin tedavisinde etkin bir ajan olduğu görülmektedir. İlave olarak,yüksek ve sabit serum seviyelerinde polietilen glikol ile kaplanmış interferonun kullanımının klasik interferon tedavisi ile kıyaslandığında daha ümit vericidir., Aim. To present follow-up results of our chronic hepatitis patients infected with HDV treated with subcutaneous interferon (IFN). Method. A total of 24 patients, 21 males and 3 females with HBsAg (+), AntiHBc IgM (-), antibody against hepatitis D virus (anti HDV) and/or HDV RNA (+) and with above normal values for serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), who had no contraindications for treatment and had suitable histological activity index (HAI) and fibrosis scores in their liver biopsies were enrolled. Patients treated with three doses of 9-10 MU subcutaneous IFN per week. Serum aminotransferases, HBsAg, antibody against HbsAg (anti HBs), hepatitis B e antigen (HBeAg), antibody against HBeAg (anti HBe), HBV DNA, anti HDV and/or HDV RNA levels were determined before, during and after treatment. Results. Nine patients (37.5%) stopped treatment in an early phase. In 3 patients (12.5%), treatment was discontinued due to severe side effects. In the post-treatment period, HBV DNA was negative in all patients. In 4 patients who completed 12-month treatment (33.3%), ALT levels decreased to normal values in the 3rd month and this level was sustained during follow-up of 24 months; in one patient, ALT levels mildly increased in the 6th and 12th months and decrease to normal values were observed in the following visits. Conclusions. High dose interferon, a proinflammatory cytokine with antiviral efficacy and biological activity spectrum, seems as an effective agent in treatment of chronic hepatitis D. In addition, use of pegylated IFNs with higher and sustained serum levels may be more promising as compared to classical IFN treatment.

Kaposi's sarcoma (KS) is an unusual malignant vascular tumor principally affecting the skin of the lower extremities. It has four clinical varieties: classic, endemic, epidemic and iatrogenic.1 The latter is described mostly in organ transplant recipients receiving high-dose and/or long-term (9 to 23 months) immunosuppressive treatment.2 In addition, KS has been shown as a rare complication in inflammatory bowel diseases (IBD) that should be related to immunosuppression.3 Oral corticosteroids and immunomodulatory drugs, such as azathioprine (AZA) and 6-mercaptopurine (6-MP) are effective in Crohn's disease, however their use is limited …

Ornidazole is generally well tolerated antibiotic which is synthetic derivative of nitroimidazole. Serious side effects are very rarely encountered. The most common side effects are metallic taste, nausea, vomiting, abdominal pain and diarrhea.1 Even though it has been presented that ornidazole has side effects (for example neurotoxicity, glossitis and stomatitis). Hepatotoxicity related to this drug has been rarely reported. Before, this phenomenon was described with the three cases by Tabak, et al.2 Herein, we presented a case of recurrent prolonged hepatotoxicity associated with ornidazole. A 45-years-old female patient was admitted to our outpatient clinic with nausea, vomiting, loss of appetite, jaundice and abdominal pain. Her past medical history revealed vaginitis treated with two days course of oral ornidazole 500 mg twice daily. She also mentioned about ornidazole associated hepatitis following use of the drug a year ago. Meanwhile, elevated liver enzymes after ornidazole treatment in that period were as follows: ALT 720 U/l, AST 690 U/l, alkaline phosphatase 161 U/l, GGT 102 U/l, total bilirubin 8.2 mg/dl, direct bilirubin 4.0 mg/dl. On admission, physical examination revealed scleral jaundice and tenderness in the right upper quadrant. Laboratory examination revealed the following: ALT 397 U/l, AST 333 U/l, GGT 68, total bilirubin 1, 94 mg/dl. Alkaline phosphatase, albumin and prothrombin time were normal. She did not consume alcohol. She did not take herbal products and concomitant medication. She had not travelled any region of the world. Laboratory tests were normal for autoimmune hepatitis, thyroid tests, haemochromatosis or Wilson's disease. Viral markers for A-E were negative. Antinuclear antibody was negative. Hepatobiliary ultrasound revealed no evidence of extrahepatic obstruction, biliary ductal disease, hepatic parenchymal abnormalities, or cholelithiasis. These findings suggested hepatocellular type liver injury related with ornidazole. After ceasing the drug, transaminase and bilirubin levels returned to normal range after two months. We didn’t perform percutaneous liver biopsy because of liver function tests decreased to normal range and the patient didn’t accept. Besides she had a history of ornidazole induced hepatotoxicity. Ornidazole induced liver injury may be cytolytic, cholestatic, and/or mixed. In this report, we described a patient recurrent hepatitis due to ornidazole. Interestingly, hepatotoxicity due to ornidazole was appeared early as compared with previous cases.3 In conclusion, ornidazole which is frequently used nitroimidazole derivative may cause recurrent hepatitis. Physicians and patients should be awareness of hepatotoxicity due to ornidazole. Early recognition and withdrawal of the drug may prevent further damage.

There are several causes resulting in decompensation of compensated cirrhosis and disturbing ascites regulation. Besides, hematologic disorders including anemia, thrombocytopenia, leucopenia and coagulation disorders may also accompany cirrhosis. In this case, we discuss a patient with liver cirrhosis on lamivudine treatment with refractory ascites and pancytopenia, who developed acute myeloblastic leukemia during the course of the disease.Keywords: Hepatitis B, liver cirrhosis, acute myeloblastic leukemia, lamivudineÖzetKompanze sirozun dekompanze olmasının ve asit regülasyonunun bozulmasının farklı nedenleri vardır. Ayrıca, anemi, trombositopeni, lökopeni ve pıhtılaşma bozuklukları gibi hematolojik bozukluklar da siroza eşlik edebilir. Bu vaka sunumunda, lamivudin kullanan karaciğer sirozlu bir hastada hastalığın seyri sırasında akut miyeloblastik lösemi gelişen refrakter asit ve pansitopenili bir vakayı tartıştık.Anahtar sözcükler: Hepatit B, karaciğer sirozu, akut myeloblastik lösemi, lamivudine, There are several causes resulting in decompensation of compensated cirrhosis and disturbing acid regulation. Besides, hematologic disorders including anemia, thrombocytopenia, leucopenia and coagulation disorders may also accompany cirrhosis. In this case presentation, we discuss a patient with liver cirrhosis on lamivudine treatment with refractory ascites and pancytopenia, who developed acute myeloblastic leukemia during the course of the disease.Key Words: Hepatitis B, liver cirrhosis, acute myeloblastic leukemia, lamivudine

Cholangitis is one of the most morbid complications of endoscopic biliary drainage and among the commonest causes of endoscopic retrograde cholangiopancreatography-related death. The aim of this prospective study was to investigate the risk factors for the development of cholangitis after endoscopic retrograde cholangiopancreatography in a tertiary referral center.The study involved 503 consecutive patients with naive papilla who underwent endoscopic retrograde cholangiopancreatography. We included the cholangitis occurring within 72 hours after endoscopic retrograde cholangiopancreatography for all patients undergoing the procedure. All patients received antibiotic prophylaxis before endoscopic retrograde cholangiopancreatography. Factors including age, gender, presentation, nature of the papilla, therapeutic procedures, and the diagnosis were analyzed to predict post-endoscopic retrograde cholangiopancreatography cholangitis.Median age was 61.2 +/- 14.8 years and there were 274 (54.5%) women and 229 (45.5%) men. Seventeen (3.3%) patients (9 F, 8 M) developed cholangitis after endoscopic retrograde cholangiopancreatography. The risk of post-endoscopic retrograde cholangiopancreatography cholangitis development was most probable in patients with hilar cholangiocarcinoma. Post-endoscopic retrograde cholangiopancreatography cholangitis risk was significantly higher in patients with biliary dilatation and biliary stent insertion, and without periampullary diverticula (odds ratio, OR: 4.8, 4.4, 1.2, respectively). Total procedure duration was significantly prolonged and common bile duct diameter was significantly increased in patients who had cholangitis. Five patients (3 F, 2 M; 0.9%) died because of post-endoscopic retrograde cholangiopancreatography complicated sepsis.Increased common bile duct diameter, biliary dilatation, biliary stent insertion, prolonged total procedure time, and hilar cholangiocarcinoma have higher post-endoscopic retrograde cholangiopancreatography cholangitis risk. Moreover, the presence of periampullary diverticula was found to decrease cholangitis risk.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by destruction and fibrosis of the bile ducts. This study aimed to demonstrate the hepatic and extrahepatic characteristic findings and prognostic outcomes of Turkish patients with PSC.The medical records of 35 consecutive patients with PSC from January 1988 to June 2007 were recorded prospectively. From the time of diagnosis, clinical features and laboratory data were collected.The mean age of the 35 patients was 41.69 years (range 15-80 years) at the time of diagnosis; 14 (40%) were female, and 21 (60%) were male. The mean duration of follow-up was 58.86 months (1-180 months). Twenty (57.1%) of the patients with PSC were asymptomatic and 22 (62.9%) had inflammatory bowel disease. At the time of diagnosis, 20 (57.1%) of the patients had both intra- and extra-hepatic PSC. Twenty-one (60%) of the patients, who had undergone ERCP for stent placement, had dominant bile duct stenosis. Cholangiocarcinoma was found in 2 (5.7%) of the patients and cirrhosis was detected in 7 (20%); 5 (14.3%) underwent liver transplantation. The median follow-up time after liver transplantation was 23 months and all are still alive. Six (17.1%) patients died.PSC has a clinical course varied from advanced liver disease requiring liver transplantation within a short time to being asymptomatic for decades. The prognosis of Turkish patients with PSC is also disappointing as described in other studies.

A 76-year-old man presented to our department complaining of dysphagiawhich had started 6 months earlier as mild and had gradually progressed for the last month. He indicated that it was mainly limited to solids and was relieved by fluids. He had no pain while swallowing. The patient was a nonsmoker and his medical history included hypertension and osteoarthritis. An upper gastrointestinal endoscopy was performed and revealed a smooth, extrinsic indentation on the left posterior wall of the mid-esophagus (●" Fig.1). The esophagus appeared otherwise normal without any evidence of the formation of any intrinsic structure. Cervical–thoracic computed tomography (CT) was performed for differential diagnosis. This revealed fusion between the T2–T5 corpora and diffuse idiopathic skeletal hyperostosis (DISH), with prominent osteophyte formation projecting anteriorly on the left at the T2–T3 level. This formation pressed on the esophagus, as shown in the CT image (●" Fig.2). Severe dysphagia related to thoracic osteophytes was diagnosed. A surgical consultation was arranged and an operation for osteophyte excision was proposed. However, the patient refused surgical intervention, so diet modification and antireflux and swallowing therapy were prescribed and explained to him. Dysphagia is a common problem in older patients and is becoming a larger health care problem. Dysphagia can occasionally be caused by giant vertebral osteophytes or exuberant bone formation associated with DISH. Almost all reported cases have resulted from large anterior osteophytes in the cervical spine, which commonly involve the hypopharynx or the cervical esophagus. It has been suggested that osteophytes are more likely to cause narrowing of the cervical esophagus, because in the cervical spine the cricoid cartilage fixes the esophagus, whereas the thoracic esophagus is a relatively mobile structure that can be displaced anteriorly or laterally without being compressed [1], and for this reason dysphagia related to thoracic esophagus involvement is very rare [2].

The aim of this study was to evaluate the results of ultrasonographic guided fine needle aspiration biopsy conducted at our clinic between 1999 and 2000.Biopsy was taken from either the liver or pancreas of 40 patients (29 male, 21 female) with a mean age of 59.7+/-11.99 years.The diameter of lesions was 2-15 cm, with 26 of 33 lesions in the liver being malignant. There was a solitary lesion in the liver being malignant. There was a solitary lesion in the pancreas in seven cases and these were found to be adenocarcinomas.This procedure is concluded to be a highly accurate diagnostic method, which is both fast and practical in clinical practice.

Dear Sir, A 48-year-old woman presented with tremor. The patient had a history of Crohn's disease of both the ileum and she had been on corticosteroid and azathioprine (AZA) treatment for 2 months. She had no history of other medications, herbal or alcohol. Two weeks ago steroid therapy was stopped by dose reduction due to exogenous Cushing syndrome and AZA 100 mg doses increased to 150 mg twice a day for optimal treatment doses (2 kg/mg/day). Involuntary, rhythmic …