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WOS: 000501595400001, PubMed: 31769896, The aim of the present study was to investigate the potential effects of isotretinoin on the biliary system in patients with acne vulgaris receiving isotretinoin therapy. This was a preliminary retrospective study involving 40 patients with severe acne vulgaris who attended the dermatology clinic and were administered different doses (20 or 30 mg/day) of isotretinoin. Serum levels of AST, ALT, ALP, GGT, total bilirubin, direct bilirubin, and indirect bilirubin at the beginning and at the first month of therapy were scanned, recorded, and statistically analyzed. Total and indirect bilirubin levels at the first month of treatment in 30 patients, receiving isotretinoin at a dose of 20 mg/day, were significantly lower compared to the baseline values (p = .02 and p = .03, respectively), whereas AST and GGT serum levels were significantly higher (p = .003 and p = .006 respectively). No significant reduction in total and indirect bilirubin levels was detectable at the first month of treatment in 10 patients receiving isotretinoin at a dose of 30 mg/day; however, AST, ALP, and GGT levels were significantly elevated in these patients (p = .023; p = .004; and p = .001, respectively). To our knowledge, there is no previous study investigating the effects of isotretinoin on the biliary system, and, therefore, the present study is a preliminary one. Our findings implicate that low dose (20 mg/day) isotretinoin therapy can potentially reduce total and indirect bilirubin levels. Long-term, large-scale, prospective studies with patients receiving different doses of isotretinoin may provide more reliable information regarding the bilirubin lowering effects of isotretinoin and optimum dosing for achieving this clinical effect.

BACKGROUNDS We evaluate whether it is safe to accept donors with Gilbert's syndrome (GS) for a living donor liver transplantation (LDLT) or not. This study is the first controlled study to be conducted. METHODS Between January 2004 and May 2014, 600 LDLTs which used right lobe liver grafts were performed in our center. Forty-five of the 600 donors had a GS diagnosis. For a control group, 99 donors without GS who had completed 1 year or more of follow-up were selected retrospectively and consecutively. The clinical results of the donors and recipients were then analyzed. RESULTS A total of 45 donors with GS and 99 donors without GS were included. There were no significant differences in patient demographics, actual graft weight, remnant ratio, portal and ductal variations, pre-peri-post-operative liver enzymes. The donors with GS had significantly higher bilirubin levels compared with the control group at first reading, at maximal peak, and post-operative 1-7 days, 1st and 6th months (P

Background The aim of this study was to determine the long-term efficacy of nucleos(t)ide analog (NA) and low-dose hepatitis B immunoglobulin (HBIG) combination treatment for preventing post-transplant hepatitis B virus (HBV) recurrence. Methods A total of 296 patients with HBV-associated liver disease who underwent liver transplantation (LT) were enrolled. A combination of a daily NA and low-dose HBIG was used after LT. Results The median follow-up period was 46 months. HBV recurrence occurred in eight patients. The cumulative probability of HBV recurrence at 1, 3, 5, and 7 years was 1%, 3%, 3%, and 4%, respectively. Seven were on lamivudine (LMV) or adefovir dipivoxil (ADV), or LMV and ADV and HBIG combination treatment and one entecavir (ETV) and HBIG. With Cox regression analysis, HBV recurrence was determined to be associated with the presence of hepatocellular cancer (HCC) prior to LT (HR: 12.3, P=.02). Overall, 44 patients died. Survival was significantly better in the ETV or tenofovir disoproxil fumarate (TDF) and HBIG group than the other group (P

Background/Aims: This study aimed at comparing the efficacy and tolerability of 5 different regimens for Helicobacter pylori eradication in recent years. Methods:H. pylori-positive patients with dyspeptic symptoms were included and separated into 5 groups. The ‘PAC group' was given pantoprazole, amoxicillin and clarithromycin for 14 days. The ‘PAM group' was given pantoprazole, amoxicillin and metronidazole for 14 days. The ‘bismuth-containing group' was given pantoprazole, bismuth subsalicylate, tetracycline and metronidazole for 14 days. The ‘sequential group' was given pantoprazole and amoxicillin for 5 days, followed by pantoprazole, tetracycline, and metronidazole for the next 5 days. The ‘concomitant group' was given pantoprazole, amoxicillin, tetracycline, and metronidazole for 10 days. Eradication was assessed through the urea breath test on 6 weeks after eradication therapy. Results: The eradication rate of intention-to-treat/per protocol were 42/48.3% in the PAC group, 52/54.2% in the PAM group, 62/77.5% in the bismuth group, 71/80.7% in the sequential group and 72/83.7% in concomitant group. The frequency of mild and moderate side effects was similar between groups. Conclusion: The concomitant and sequential therapies are an effective treatment for H. pylori. Bismuth-containing therapy is superior to conventional triple therapies; however, the eradication rate is not satisfactory. In our country, conventional triple therapies are not effective for eradication.

Background/aims Hepatorenal syndrome (HRS) is a severe complication of advanced cirrhosis and is characterized by renal dysfunction and poor survival rates. Although anemia is a non-rare condition in advanced liver cirrhosis, there is no publication regarding the potential or additive effects of anemia on HRS and renal dysfunction in patients with cirrhosis. We investigated whether severe anemia is a precipitant factor for HRS. Materials and methods In this prospective study, consecutive patients with cirrhosis with and without renal dysfunction were enrolled. A total of 29 patients with cirrhosis with HRS meeting the HRS diagnostic criteria (9 patients with type 1 HRS and 20 with type 2 HRS) and 37 patients with cirrhosis without HRS were included. The demographic features, laboratory data (particularly anemic parameters), and clinical scores of patients with and without HRS were evaluated. Results Grades of ascites, Child-Turcotte-Pugh (CTP) scores, and Model of End Stage Liver Disease (MELD) scores were significantly higher in contrast to hemoglobin levels; hematocrit concentrations were significantly lower in patients with type 1 and 2 HRS than in those with non-HRS stable cirrhosis. There was a negative correlation between the hemoglobin-hematocrit and serum creatinine levels. In the logistic regression analysis, the hemoglobin levels and CTP and MELD scores were statistically significant for an onset of HRS. Conclusion Anemia may contribute to HRS and deteriorated renal function in patients with HRS because anemic hypoxia can lead to microcirculatory renal ischemia in the kidneys and anemia can also activate sympathetic activity and hyperdynamic circulation in the pathogenesis of HRS.

Angiomyolipomas (AMLs) are a benign mesenchymal tumor that typically occurs in the kidney and very rare in the liver. Even though these tumors can be diagnosed with imaging tecniques, diagnosis mainly relies on pathological findings. Because AMLs can mimic other hepatic tumors such as hepatocellular carcinoma (HCC) on radiologic images due to some of the features. We presented a giant hepatic AML case which mimicing hepatocellular carcinoma in imaging techniques. We suspected from hepatocellular carcinoma according to radiologic images, but biopsy result was hepatic angiomyolipoma. There are potential risks such as spontaneous rupture and malignant transformation of these tumors. The effective therapy of hepatic AML is surgical resection., Anjiyomyolipomlar, tipik olarak böbrekte görülen ve karaciğerde çok nadir olan benign mezenkimal tümörlerdir. Bu tümörler görüntüleme teknikleri ile teşhis edilebilse de, tanı esas olarak patolojik bulgulara dayanır. Çünkü anjiyomyolipomlar radyolojik görüntülerde bazı özellikleri nedeniyle hepatoselüler karsinom gibi diğer karaciğer tümörlerini taklit edebilirler. Biz görüntüleme tekniklerinde hepatoselüler karsinomu taklit eden bir hepatik anjiyomyolipom vakasını sunduk. Radyolojik görüntülere göre hepatoselüler karsinomdan şüphe ettik, fakat biyopsi sonucu hepatik anjiyomyolipom idi. Bu tümörlerin malign transformasyon ve spontan rüptür gibi potansiyel riskleri vardır. Hepatik anjiyomyolipomların efektif tedavisi cerrahi rezeksiyondur

Alström syndrome is a rare autosomal recessive genetic disorder characterized by cone-rod dystrophy, hearing loss, childhood truncal obesity, insulin resistance and hyperinsulinemia, type 2 diabetes, hypertriglyceridemia, short stature in adulthood, cardiomyopathy, and progressive pulmonary, hepatic, and renal dysfunction. Alström syndrome is a very rare cause of liver cirrhosis. Postmortem biopsies of patients with Alström syndrome show relevant fibrosis in multiple organs especially in the liver, kidneys, heart, and lungs. We report the case of a patient with Alström syndrome who presented to emergency department with esophageal variceal bleeding and who was not known to have hepatic cirrhosis before.

Extraintestinal manifestations are well described in inflammatory bowel disease. A 63 year-old male was admitted to our clinic with the complaint of dyspnea and dry cough. Echocardiography revealed minimal pericardial effusion. He was prescribed ibuprofen 600 mg twice on a daily basis. Four days later, he was admitted to the hospital due to palpitations, chest pain and increased dyspnea. From the medical history results, it was clear that the patient had ulcerative colitis and did not have medical treatment for the last sixth months. He was treated with oral prednisolone and mesalamine. Within six days, his bowel symptoms as well as his cardiac symptoms improved for the better, and the patient was discharged in good condition on day six after his admission to hospital. Pericardial effusion was completely resolved. Ulcerative colitis, which may not be detected as an underlying cause, should be considered in pericardial effusion cases as differential diagnosis. Key words: Pericardial Effusion; Ulcerative Colitis; Corticosteroid Theraphy., İnflamatuar barsak hastalıklarında barsak dışı belirtiler iyi tanımlanmasına rağmen kardiyak tutulum nadiren bildirilmiştir. 63 yaşında erkek hasta nefes darlığı ve kuru öksürük şikayeti ile kardiyoloji polikliniğine başvurdu. Ekokardiyografide minimal perikardiyal effüzyon vardı. Günde iki kez 600 mg İbuprofen reçete edildi. Hasta çarpıntı, göğüs ağrısı ve nefes darlığında artma olması üzerine dört gün sonra hastaneye başvurdu. Kardiyoloji servisine yatırıldı. Tıbbi hikayesinde ülseratif kolit tanısı olduğu ve altı aydır tedavi almadığı belirlendi. Tekrar yapılan ekokardiyografide effüzyonun arttığı ve sağ atriyuma bası olduğu tespit edildi. Oral prednizolon ve mesalamin ile tedavi edildi. Altı gün içinde göğüs belirtilerine ilaveten barsak belirtileri düzeldi ve hastaneye başvurduktan altı gün sonra iyi durumda taburcu edildi. Bu sürede perikardiyal effüzyon tamamen gerilemişti. Nedeni tespit edilemeyen perikardiyal effüzyon vakalarında ayırıcı tanıda ülseratif kolit mutlaka düşünülmelidir. Anahtar kelimeler: Perikardiyal Effüzyon; Ülseratif Kolit; Kortikosteroid Tedavisi.

Amaç: Kronik hepatit B virüs (HBV) enfeksiyonu global bir sağlık problemi olup artmış morbidite ve mortalite ile ilişkilidir. Tedavideki ana hedef HBV replikasyonunu sürekli bir şekilde baskılayabilmektir. Ancak antiviral direnç kalıcı supresyon önünde ciddi bir engel teşkil etmektedir. Ülkemizde lamivude yanıtsız hastalarda tenofovire olan yanıtının değerlendirilmesi ile ilgili yeterli verilerin olmaması nedeniyle, bu çalışmanın yapılması planlanmıştır.Gereç ve Yöntemler: On sekiz yaşından büyük, en az 6 ay lamuvudin kullanmış ve direnç tespit edildikten sonra tenofovir başlanmış 48 hasta çalışmaya alındı. Hastaların tenofovir öncesi ve sonrası HBV DNA düzeyleri, hepatit B e antijen (HBeAg) serokonversiyonu ve hepatit B yüzey antijeni (HBsAg) kaybı oranları retrospektif olarak incelendi.Bulgular: Lamivudin direnci sonrası tenofovir alan hastalarda viral supresyon (HBV DNA 400 kopya/ml) tedavinin 6. ayında %89, 12. ayında %94 ve ortalama 21,4 aylık tedavi sonrası ise %96 oranında saptandı. Alanin aminotransferaz normalizasyonunun tedavinin birinci yılında %60 ve 21,4 aylık izlem süresinin sonunda ise %90 oranında sağlandığı görüldü. Tedavinin birinci yılında HBeAg kaybı %42 hastada tespit edildi. HBsAg kaybı izlem periyodu boyunca hiçbir hastada saptanmadı.Sonuç: Lamivudine yanıtsız kronik hepatit B hastalarında tenofovir etkili ve iyi tolere edilebilen bir tedavi seçeneğidir., Objective: Chronic hepatitis B virus (HBV) infection is a global health problem and persistent viremia is associated with increased morbidity and mortality. The main goal of hepatitis B treatment is to suppress HBV replication permanently and, antiviral resistance is a major problem against viral suppression. Tenofovir is a potent antiviral drug with no reported resistance so far. There are inadequate data regarding response to tenofovir in chronic hepatitis B patients with lamivudine failure in Turkish population. The present study was conducted to evaluate response of tenofovir in patients with lamivudine failure.Materials and Methods: A total of 48 adult patients with chronic hepatitis B, who have received lamivudine for at least 6 months and switched to tenofovir due to lamivudine failure were investigated retrospectively. HBV DNA levels, alanine aminotransferase (ALT) levels and serum creatinine levels were evaluated before and after tenofovir treatment and also hepatitis B e antigen (HBeAg) seroconversion and hepatitis B surface antigen (HBsAg) loss rates were evaluated.Results: Viral suppression rates (HBV DNA >400 copies/ml) were found to be 89% on the 6th month and 94% on the 12th month of tenofovir treatment. The mean follow-up time was 21.4 months and totally 96% of patients were found to achieve viral suppression with tenofovir. ALT normalization rates were found to be 60% on the first year of treatment with tenofovir and overall ALT normalization rate was 90%. HBeAg seroconversion was detected in 42% of HBe antigen () patients after the first year of tenofovir treatment and disappearance of HBsAg was observed in none of the patients.Conclusion: Tenofovir treatment is an effective and well-tolerated therapeutic option in chronic hepatitis B resistant to lamivudine.

OBJECTIVES Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. MATERIALS AND METHODS This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. RESULTS There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P

Background & Aims: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase-associated lipocalin (NGAL) is a troponin-like biomarker for human acute kidney injury. We aimed to investigate levels of plasma and urine NGAL in HRS and predictive ability of these markers for all-cause mortality, in HRS, stable cirrhosis and control subjects. Methods: A total of 64 patients with cirrhosis (8 patients with type 1 HRS, 22 with type 2 HRS, and 34 without HRS) and 23 control subjects were included in the study. Blood and urine samples were measured with Human NGAL sandwich ELISA. Patients were followed up prospectively. Results: Patients with type 1 and type 2 HRS had significantly higher plasma and urine NGAL levels compared with stable cirrhosis and control subjects. Cox regression analysis showed that plasma NGAL and MELD-Na scores were independent predictors of mortality. ROC-curve analysis showed that the plot of the plasma NGAL, urine NGAL, MELD-Na and ChildTurcot-Pugh score could predict all-cause mortality in cirrhotic patients’ area under the curve (AUC 0.819, 0.686, 0.807 and 0.795 respectively). Conclusions: NGAL could predict mortality in patients with HRS independent of other commonly used risk factors.

Variceal bleeding is the major complication of portal hypertension in patients with liver cirrhosis. Hemorrhage mainly occurs in gastrointestinal lumen. Extraluminal hemorrhages are quite rare, such as intraperitoneal hemorrhages. We aimed to present a variceal bleeding case from the anastomosis on the anterior abdominal wall, as an extraordinary bleeding location, in a patient with portal hypertension in whom there were no esophageal and gastric varices.

To prospectively assess the hemostatic efficacy of the endoscopic topical use of ankaferd blood stopper (ABS) in active non-variceal upper gastrointestinal system (GIS) bleeding.Endoscopy was performed on 220 patients under suspiciency of GIS bleeding. Patients with active non-variceal upper gastrointestinal bleeding (NVUGIB) with a spurting or oozing type were included. Firstly, 8-10 cc of isotonic saline was sprayed to bleeding lesions. Then, 8 cc of ABS was applied on lesions in which bleeding continued after isotonic saline application. The other endoscopic therapeutic methods were applied on the lesions in which the bleeding did not stop after ABS.Twenty-seven patients had an active NVUGIB with a spurting or oozing type and 193 patients were excluded from the study since they did not have non-variceal active bleeding. 8 cc of ABS was sprayed on to the lesions of 26 patients whose bleeding continued after isotonic saline and in 19 of them, bleeding stopped after ABS. Other endoscopic treatment methods were applied to the remaining patients and the bleeding was stopped with these interventions in 6 of 7 patients.ABS is an effective method on NVUGIB, particularly on young patients with no coagulopathy. ABS may be considered as part of a combination treatment with other endoscopic methods.