Search

Hepatocellular carcinoma is the most common primary liver tumor. Hepatocellular carcinoma usually makes metastasis to bones. Prognosis of bone metastasis of hepatocellular carcinoma is becoming better with early diagnosis and improvements in treatment modalities. As survival increases, bone metastasis is faced more. However, humerus metastasis is very rare. Bone metastasis may result in symptoms and pathologic fractures. Hepatocellular carcinoma metastasis of bone worsens patients’ quality of life. Early diagnosis and proper treatment are very important. Herein we report a rare case with humerus metastasis of hepatocellular carcinoma which is treated with resection and endoprosthesis., Hepatosellüler karsinom karaciğerin en sık görülen primer tümörüdür. Hepatosellüler karsinom sıklıkla kemiklere metastaz yapar. Hepatosellüler karsinom prognozu erken tanı ve tedavi modalitelerindeki ilerleme nedeniyle giderek daha iyi hale gelmektedir. Sağkalım arttıkça kemik metastazları ile daha çok karşılaşılmaktadır. Bununla birlikte humerus metastazı çok nadirdir. Kemik metastazları semptomlar ve patolojik fraktürlerle sonuçlanabilir. Hepatosellüler karsinomun kemik metastazı hastanın yaşam kalitesini kötüleştirebilir. Erken tanı ve uygun tedavi çok önemlidir. Burada hepatosellüler karsinomun humerus metastazı olan ve rezeksiyon ve endoprotez ile tedavi edilen nadir bir olguyu sunacağız.

BACKGROUND: In patients with ulcerative colitis, endoscopic and clinical indices are used to assess the disease activity. In addition, studies have been carried out for easier and cheaper markers in recent years. For this purpose, we evaluated the monocyte/high-density lipoprotein ratio of the disease activity. METHODS: According to clinical activity and partial Mayo scores, a total of 114 patients, 53 in the active ulcerative colitis group and 61 in the ulcerative colitis remission group were included in the study. Monocyte/high-density lipoprotein ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate measurements of these 2 groups were recorded. Ulcerative colitis remission group and active ulcerative colitis group were compared in terms of activity. RESULTS: The monocyte/high-density lipoprotein ratio value in the active ulcerative colitis group was significantly higher than that of the ulcerative colitis remission group (10.68 ± 3.39, 6.68 ± 1.39, P < .001, respectively). The monocyte/high-density lipoprotein ratio value for active ulcerative colitis at a cut-off value of 7.4 had 83% sensitivity and 81% specificity. In the active ulcerative colitis group, neutrophil/lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate values were significantly higher than the ulcerative colitis remission group (P < .001, P < .001, P < .001, respectively). CONCLUSION: Monocyte/high-density lipoprotein ratio is an inexpensive and effective marker that can be used to determine the activity of ulcerative colitis.

Rectovaginal fistula is usually observed due to obstetric traumas during giving birth, rectal or gynecologic malignities or after surgical therapy of malignant lesions or radiotherapy. Rectovaginal fistulas are not common in general surgery and gynecology clinics. However, these lesions are rarely seen during gastroenterology practice. In gastroenterology practice, we may face with rectovaginal fistula during Crohn’s disease’s course. These lesions deteriorate patients’ quality of life and increase morbidity and mortality. Endoscopy may be used to detect the localization of fistula and may help to choose correct treatment modality. Endoscopy sometimes may also be used to treat rectovaginal fistula via endoclips or stents. Typical complaints for rectovaginal fistulas are air, gas, or mucus discharge from vagina. Dyspareunia, perineal pain, or recurrent vaginal infections may also be seen. Rectal bleeding is not a common complaint for rectovaginal fistulas. Herein we report a rare case with rectovaginal fistula presenting with massive rectal bleeding after debulking surgery for ovarian carcinoma., Rektovajinal fistüller genellikle doğum sırasındaki obstetrik travmalara, rektal veya jinekolojik malignitelere bağlı, malign lezyonların cerrahi veya radyoterapisi sonrası görülür. Rektovajinal fistüllere en çok genel cerrahi ve jinekoloji kliniklerinde rastlanır. Bununla birlikte bu lezyonlar gastroenteroloji pratiğinde nadiren görülür. Gastroenteroloji kliniğinde rektovajinal fistüllerle Crohn hastalığı seyrinde karşılaşabiliriz. Bu lezyonlar hastaların yaşam kalitesini kötüleştirir, morbidite ve mortaliteyi arttırır. Endoskopi, fistül lokalizasyonunu saptamada ve doğru tedavi modalitesini seçmede yardımcı olabilir. Endoskopi bazen de endoklip veya stent kullanılarak tedavide kullanılabilir. Rektovajinal fistülün tipik şikayetleri vajinadan hava, gaz veya mukus gelmesidir. Disparöni, perineal ağrı veya rekürren vajinal enfeksiyonlar da görülebilir. Rektal kanama sık görülen bir bulgusu değildir. Burada over karsinomu nedeniyle debulking cerrahi operasyonu sonrası massif rektal kanama ile presente olan nadir bir rektovajinal fistül vakasını sunacağız.

Introduction Postoperative benign anastomotic strictures (POBAS) which develop after surgical resections of the gastrointestinal system (GIS) present with symptoms depending on location of the stricture. Diagnosis is confirmed by endoscopic and radiological methods. Although bougie or balloon dilatation is preferred in management, the endoscopic incision method (EIM) is also used with considerable success. In this trial, we aimed to evaluate EIM, which is one of the endoscopic dilatation techniques used in postoperative anastomotic stricture of GIS. Material and methods A total of 20 POBAS patients, 12 men and 8 women, subjected to EIM intervention for strictures, were enrolled in the trial. The number of patients with upper GIS strictures was 6 (30%), while the number of cases with lower GIS strictures was 14 (70%). Results Dilatation of the stricture was achieved in 15 (75%) patients with one treatment session, while more than one session of EIM was needed in 5 (25%) cases. Mean duration of follow-up of patients was 10.65 ±5.86 (0–25) months. Procedure-related complications developed in 8 patients. Among them, 7 were minor complications and improved without any treatment. In only 1 (5%) patient, perforation was observed as a major complication. Following EIM, recurrence of POBAS was observed in 5 (25%) patients. The following parameters were found to have an impact on successful outcome in EIM: presence or absence of a tortuous lumen in POBAS (p = 0.035) and length of stricture (p = 0.02), complications during the procedure (if any), and presence of single or multiple strictures. Conclusions Endoscopic incision method may be regarded as a favorable approach among first choice treatment alternatives in uncomplicated anastomotic strictures of GIS, or it may be used as an adjunctive dilatation method.

Savaş, Ayla Yıldız (Balikesir Author), OBJECTIVE: The incidence of gastric polyps (GPs) greatly differs according to study populations and was found to be 0.33%-6.7% in various studies. The majority of GPs are composed of hyperplastic polyps (HPs), fundic gland polyps (FGPs), and adenomatous polyps (APs). Although APs have a high risk of malignant potential, sporadic FGPs have no malignant potential. Conversely, HPs have a low risk of malignant potential. It is not sufficient to perform a biopsy to identify the polyp type and the presence of dysplasia; thus, some polyps may require multiple biopsies or total excision. METHODS: This retrospective study included patients with GPs or polypoid lesions found on esophagogastroscopy with polyp or malignant histology on biopsy at Ankara Numune Training and Research Hospital Endoscopy Unit between 2005 and 2011. RESULTS: In a series of 56.300 upper endoscopies, 192 patients (0.34%) were found to have GPs. Among the patients, 51 (26.6%) were men and 151 (73.4%) were women. The average age of the patients was 61.9 +/- 13.3 (14-90) years. The frequency of HPs, APs, and FGPs were 88%, 2.6%, and 1.6%, respectively. The size of the polyps was

Dieulafoy's lesion is an uncommon, but important, cause of upper gastrointestinal bleeding. Dieulafoy's lesion is usually seen in the stomach, but sometimes can be seen in the small or large bowel. Typically, it is located within 6 cm of the esophagogastric junction, generally along the lesser curvature of the stomach. Various methods with endoscopy are used to control the hemostasis due to these lesions, but the most suitable endoscopic treatment method for treating bleeding Dieulafoy's lesion is not yet well established. Argon plasma coagulation has been used successfully in upper gastrointestinal bleeding; however, the experience using argon plasma coagulation to treat Dieulafoy's lesion is quite limited. Herein, we report a case with a bleeding gastric Dieulafoy's lesion that was treated using a combined endoscopic approach with injection therapy and argon plasma coagulation, Dieulafoy lezyonu nadir görülen ancak önemli bir üst gastrointestinal kanama nedenidir. Sıklıkla midede görülmekle birlikte ince ve kalın bağırsaklarda da görülebilir. Tipik olarak gastroözofageal bileşkeden sonraki 6 cm içinde, küçük kurvatur yönünde yerleşir. Bu lezyonlara bağlı kanamada, hemostazı sağlamak için değişik endoskopik yöntemler kullanılır ve kanayan Dieulafoy lezyonu tedavisi için en uygun endoskopik tedavi yöntemi henüz iyi tanımlanmamıştır. Argon plazma koagülasyonu üst gastrointestinal kanamada başarılı bir şekilde kullanılmasına rağmen Dieulafoy lezyonuna bağlı kanamalarda kullanımı sınırlıdır. Burada enjeksiyon tedavisi ve argon plazma koagülasyonu ile kombine olarak tedavi edilen, kanayan gastrik Dieulafoy lezyonu olan olguyu sunacağız.

[Cukurova Med J 2016; 41(0.100): 126-127]

Yoğun bakıma yatan sirozlu hastaların prognozunu değerlendirmek önemlidir. Sirozlu hastaların prognozu hepatik yetmezliğin derecesi, sirozun komplikasyonları ve eşlik eden karaciğer dışı nedenlere bağlıdır. Sirozlu hastalarda prognozu daha objektif değerlendirmek için çeşitli skorlama sistemleri kullanılmaktadır. Bu çalışmada amaç yoğun bakıma yatan sirozlu hastaların prognozunu tayin etmek için kullanılan Child-Turcotte-Pugh (CTP) skoru ve Model for End-stage Liver Disease (MELD) skoru ile yoğun bakıma yatan hastaların prognozunu tayin etmek için kullanılan prognostik modellerden Acute Pysiology and Chronic Healt Evaluation (APACHE) II ve Sequential Organ Failure Assesment (SOFA) skorunun kullanılabilirliğini göstermek ve birbirine üstünlüklerini karşılaştırmaktır.Çalışmamıza, Dahiliye yoğun bakım ünitelerine Ocak 2004- Aralık 2006 tarihleri arasında yatırılarak izlenen 130 (% 64,7) erkek, 71 (% 35,3) kadın olmak üzere toplam 201 sirozlu hasta dahil edildi. Hastalarda mortaliteyi etkileyen risk faktörleri kullanılan belirteçler olarak; yaş, cinsiyet, Child-Turcotte-Pugh skoru, Model for End-stage Liver Disease skoru Acute Pysiology and Chronic Healt Evaluation II skoru, Sequential Organ Failure Assesment skoru, serum laktat, kan üre azotu, kreatinin, bilirübin, protrombin zamanı, protein elektroforezi, sirozun etyolojisi, mekanik ventilatör ihtiyacı, yoğun bakımda kalış süresi, sirozun komplikasyonları olan Hepatosellüler kanser, hepatik ensefalopati, gastrointestinal kanama, hepatorenal sendrom, spontan bakteriyel peritonit ve diğer enfeksiyonlar değerlendirildi. Bu belirteçlerin bunların prognoza etkileri araştırıldı.Sonuç olarak yoğun bakım ünitesine yatan sirozlu hastalar ileri evre hastalığa sahiptir. Bu hastalar genelde sirozun komplikasyonları nedeniyle yoğun bakıma yatırılmaktadır. Mortalite oranı oldukça yüksektir (% 41,8). Prognozu tahmin etmek için Child-Turcotte-Pugh, Model for End-stage Liver Disease, Acute Pysiology and Chronic Healt Evaluation II ve Sequential Organ Failure Assesment skoru kulanılabilir. Prognozu tahmin etmede Sequential Organ Failure Assesment ve Acute Pysiology and Chronic Healt Evaluation II skoru, Model for End-stage Liver Disease ve Child-Turcotte-Pugh skorundan üstündür (AUROC değerleri sırasıyla 0,847, 0,821, 0,790 ve 0,724). Sequential Organ Failure Assesment skoru kolay uygulanan prognozu en iyi tahmin eden skordur. Sirozun prognozunu saptamada en sık kullanılan skorlama sistemi olan Child-Turcotte-Pugh skorunun prognozu değerlendirme gücü düşüktür. Laktat düzeylerinin yüksek olması kötü prognozla ilişkilidir. Laktat prognostik parametre olarak kullanılabilir.Anahtar kelimeler: Dahiliye yoğun bakım, prognoz, Laktat, Siroz, SOFA skoru It is very important to determine the prognosis of cirrhotic patients in intensive care unit. Prognosis of cirrhotic patients depends on the degree of hepatic failure, complications of cirrhosis and concominant other extrahepatic reasons. Several scoring systems are used to evaluate cirrhotic patient?s prognosis objectively. In this study we aimed to show and compare the usability of scoring systems that are used in cirrhotic patients Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD) with other scoring systems that used in intensive care unit such as Acute Pysiology and Chronic Healt Evaluation (APACHE ) II and Sequential Organ Failure Assesment (SOFA)201 patients ,130 (% 64,7) male and 71 (% 35,3) female, were included in this study who are admitted to the internal medicine intensive care unit betweeen january 2004 and december 2006. As a risk factor of mortality age, sex, Child-Turcot-Pugh score, Model for End-stage Liver Disease score, Sequential Organ Failure Assesment II score, Sequential Organ Failure Assesment score, serum lactate, blood urea nitrogen, creatinin, total bilirubin, protrombin time, protein electrophoresis, ethyology of cirrhosis, need for mechanical ventilation, duration of hospitalization in intensive care unit, cirrhosis complications such as hepatocellular cancer, gastronintestinal bleeding, hepatorenal syndrome, spontaneus bacterial peritonitis and other infections were evaluated and investigated their influences on prognosis.As a result the patients in the intensive care unit cirrhotic patients were in advanced disease. Because of their cirrhotic complications, these patients generally admitted to the intensive care unit. Mortality rate was quite high (% 41,8). Child-Turcotte-Pugh, Model for End-stage Liver Disease, Acute Pysiology and Chronic Healt Evaluation II, Sequential Organ Failure Assesment and score can be used to predict mortality. Sequential Organ Failure Assesment and Acute Pysiology and Chronic Healt Evaluation II score were powerful to predict mortality than Model for End-stage Liver Disease score and Child-Turcotte-Pugh score (AUROC values respectively 0,847, 0,821, 0,790 and 0,7249). Sequential Organ Failure Assesment score can be performed easily and is the best scoring system. Although Child-Turcotte-Pugh score is most used scoring system in cirrhotic patients, its power to determine prognosis is low. Higher lactate values were assosiated with worse prognosis. Lactate values can be used as a prognostic parameter.Key Words: intensive care unit, prognosis, laktat, Cirrhosis, SOFA score 65