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Using the test scores of more than 1,000,000 students who participated in the Advanced Placement Computer Science (AP CS) exams from 1997 to 2020, this study examined the direction and magnitude of the trends in gender disparity in participation and top achievement in advanced exams. The findings indicated that the male-to-female ratio (MFR) among AP Computer Science (CS) exam participants declined from 4.87 to 2.26 between 1997 and 2020. Similarly, the MFR among top scorers (students who scored 5 out of 5) in any type of AP CS exams declined rapidly, in favor of female students, from 8.00 to 2.14 during the same period. Possible implications of these findings for educators, particularly for AP CS teachers and school counselors, were also discussed in the context of the underrepresentation of females in computing fields.

Real Engagement in Active Problem Solving (REAPS) cultivates exceptional talent across disciplines through students solving problems that are real in their lives. In this study, the focus was on scientific talent: to determine students’ growth in creative problem solving in science in classrooms in which REAPS was implemented. Using a repeated measures t-test, we found statistically significant changes in total creative problem solving in science across two tasks: ‘Problems and Solutions’ and ‘Grouping Flowers’ (M = 3.82, SD = 20.72, p = .01). Using multivariate regression, the level of fidelity of implementation of REAPS explained 9.8% of the variance in total creative problem solving in science across both tasks (p = .04). Differences were found in sub-scores in both analyses. We recommend use of REAPS to develop transformational scientific talent by engaging students in solving problems that are real and important in their world.

Analyzing the test scores of more than 10,000,000 students who participated in the Advanced Placement (AP) math exams from 1997 to 2019, this study examined the direction and magnitude of the trend in gender disparity by race in participation in and top achievement on AP Calculus AB, Calculus BC, and Statistics exams. The results of this study indicated that, in general, females’ representation in all three AP exams increased significantly. Although the findings indicated that the female-to-male ratios (FMRs) in participation in the AP math exams increased significantly from 1997 to 2019 and favored females for all races, the gender disparities among top achievers for all math exams are still substantial. The relationships between the FMRs in participation and top achievement for all AP math exams were also analyzed within races, and the possible impacts of these findings within the context of the underrepresentation of women in science, technology, engineering, and mathematics (STEM) fields were also discussed.

Using the test scores of more than 2,250,000 students who participated in the American Mathematics Competitions (AMC) from 2009 to 2019, this study examined the direction and magnitude of the trends in gender disparity in participation and high achievement in self-select mathematics exams. The results of this study indicated that the male to female ratio among the AMC participants increased significantly from 2009 to 2019. The findings also showed an established disparity that favored males for each year and for all competitions in both the top 1% and 5% levels, while the trend in the male to female ratios over a decade was stable, except for the top 1% of the population in the AMC 8, in which there was a significant increasing trend that favored males. The possible impacts of these findings within the context of the underrepresentation of women in STEM (science, technology, engineering, and mathematics) fields are discussed.

A persistent problem in education is underrepresentation of certain cultural and linguistic groups such as American Indian, African American, and Hispanic, in special programs for exceptionally talented students, especially in science, technology, engineering, and mathematics (STEM). An assessment with demonstrated reliability and validity as an instrument to identify exceptionally talented students was included with new instruments created in the X project. A continuum of problems, including closed, semi-open, and open-ended, was an important component of the assessment, enabling the assessment of creativity as well as understanding of mathematics concepts. The math assessment was field tested in five high schools in high poverty areas that also had high percentages of American Indian or Hispanic students. It was implemented as part of a battery of instruments to identify students to participate in a special internship program. The test–retest reliability and construct, concurrent, and predictive validity need to be investigated in future studies.

Teaching is more effective when students are taught through research-based teaching approaches that have been found to be successful in producing the outcomes they advocate. However, use of an effective instructional strategy does not ensure learning, because the success of a sound approach is determined by how well it is implemented. The purpose of this study was to evaluate the effect of the fidelity of implementation of the Real Engagement in Active Problem Solving (REAPS) teaching model on changes in creative problem solving in mathematics. REAPS is a teaching model that was initially designed to meet the needs of exceptionally gifted and talented learners. However, teachers and researchers have found it to be an effective method for teaching all students. Using a repeated measures t-test, we found that creative problem solving of students in a school in which all teachers implemented the REAPS model improved significantly in total scores as well as accuracy and concept subscores. In addition, we found that the level of fidelity of implementation of the model explained 14.8% of the variance in total creative problem solving in mathematics, 20.1% of the variance in accuracy subscore, and finally 4.5% of the variance in concept subscore. We found evidence that teachers can make a significant impact on students’ creative problem solving in mathematics through a high level of fidelity of implementation of the REAPS model.

Exceptional talent includes the ability and willingness to solve varied, complex problems, and having a knowledge structure that facilitates problem solving and creativity. The purpose of this study was to determine changes in students’ knowledge structures resulting from fidelity of implementation of Real Engagement in Active Problem Solving (REAPS), a vehicle for igniting, cultivating, extending, and strengthening exceptional talent. Using regression analysis, we found teachers’ fidelity of implementation was a significant predictor of student growth (F [4, 413] = 7.194, p < .001) in total scores and subscores on concept maps, a measure of knowledge structure. Implementation of principles for talent development in the dimensions of content, processes, products, and learning environment had differential, but positive, effects. Because concept maps have no ceiling, students already scoring at high levels can show growth. Concept maps can be used as assessments of learning, for learning, and as learning.

The aims of the present study were to review biliary complications following liver transplantation in a single-center experience, to identify the factors associated with biliary complications, and to evaluate the success of endoscopic and percutaneous treatment in such patients.Between January 1994 and June 2010, a total of 176 patients with liver disease underwent liver transplantation; 119 recipients were included in this retrospective analysis. Median posttransplant follow-up period was 49 months.Mean age was 43.0±12.7 years. Living donor liver transplantation (LDLT) and deceased-donor liver transplantation (DDLT) were performed in 71 and 48 patients, respectively. Duct-to-duct anastomosis and Roux-en-Y hepaticojejunostomy were performed in 68 and 51 patients, respectively. The overall incidence of posttransplant biliary complications was 36%; anastomotic biliary strictures were the most common biliary complications (42%), followed by biliary leakage (28%). On logistic regression analysis, duct-duct anastomosis was the only risk factor associated with the development of biliary complications (Odds ratio (OR), 3.346; p=0.005). Endoscopic and percutaneous treatment was successful in the majority of patients (81%), and the remaining 19% recipients underwent surgery for biliary repair. Endoscopic retrograde cholangiopancreatography (ERCP) guided drainage and balloon dilatation with stent placement were the most common treatment modalities.Biliary complications were most frequent after liver transplantation; biliary strictures were the most commonly seen. The use of duct-to-duct anastomosis for biliary reconstruction is a risk factor for the development of biliary complications. Endoscopic and percutaneous treatment was successful in the majority of these patients.

In this qualitative study the researchers explored children’s perceptions of their participation in a science class in which an elementary science curriculum, the Full Option Science System (FOSS), was combined with an innovative teaching model, Real Engagement in Active Problem Solving (REAPS). The children were capable of articulating views about their learning experiences during science classes. Meaningful experiences with deep levels of engagement were those that involved hands-on activities, such as experiments, provided by the FOSS curriculum; and problem-solving and model building, which were components of the REAPS model. Students’ perceptions demonstrated in their drawings were similar to their interviews, which were evidence of their meaningful science learning experiences. Incorporating students’ voices, as a type of feedback for teaching and learning, is important for teachers and practitioners; innovative pedagogical models contribute to meaningful and long-lasting science learning.

The aims of this study were to assess hepatitis B surface antigen (HBsAg) seroconversion and to determine its impact on the natural course of the disease in patients with HBeAg-negative chronic hepatitis B (CHB) during lamivudine (LMV) treatment. A total of 183 consecutive patients with HBeAg-negative CHB who were treated with LMV were included in the study. Data were retrospectively collected from outpatient visit charts. The primary endpoint was HBsAg seroconversion to anti-HBs. The secondary endpoint was to determine the development of cirrhosis. Loss of HBsAg was confirmed in 10 patients and seroconversion to anti-HBs in nine patients during LMV treatment or after its discontinuation. HBsAg seroconversion was achieved on-treatment in four patients after a median treatment duration of 30 months and off-treatment in the remaining five patients in a median 61 months after LMV discontinuation. The cumulative probability of HBsAg seroconversion increased from 0.6% at 1 year and 1.9% at 5 years to 21.5% at 10 years of LMV during and after LMV treatment. HBsAg clearance was preceded by undetectable serum hepatitis B virus (HBV) DNA. The majority of the patients responding to treatment had undetectable HBV DNA levels at 24 weeks of treatment. The cumulative probability of LMV resistance increased from 2.2% at 1 year to 37.3% at 5 years. No baseline parameter predicting either HBsAg seroconversion or the emergence of LMV resistance was identified. None of the patients with HBsAg seroconversion experienced virological breakthrough or disease progression during the follow-up period. These results indicate that HBsAg seroclearance can occur in patients with HBeAg-negative CHB under LMV therapy and predicts better clinical outcome.

Background and aims: The success of Helicobacter pylori eradication using triple eradication therapy declines over time. In this prospective study, we have compared a group of naive H. pylori-positive patients receiving sequential therapy with our previously published naive H. pylori-positive control group who received ranitidine bismuth citrate -clarithromycin-amoxicillin eradication treatment. Moreover, the eradication success of these two treatment protocols was compared with that of recent standard triple eradication treatment results for the naive patients in our country and western communities. Methods: We performed invasive tests for H. pylori in naive patients who underwent gastroduodenoscopy in the Endoscopy Unit, Ankara University, Faculty of Medicine, and patients who were diagnosed as H. pylori-positive by these tests were rechecked by the same invasive tests one month after the completion of eradication treatment. The group receiving sequential therapy was given pantoprazole + amoxicillin during the first seven days and pantoprazole + metronidazole + tetracycline during the second seven days. These patients were compared with the H. pylori-positive naive control group patients, who were given ranitidine bismuth citrate + clarithromycin + amoxicillin. The patients in whom eradication was achieved in the 4th week with sequential therapy were reevaluated one year later regarding the success of eradication with the H. pylori stool antigen test. Results: The average age of the 108 patients who received the sequential therapy was 45.2 +/- 12.5 years. The average age of the 75 patients who received ranitidine bismuth citrate treatment was 41.2 +/- 12.6 years. Six (5%) patients in the consecutive treatment group developed deterioration in taste in the mouth and 10 (9%) developed diarrhea. However, no side effects severe enough to require discontinuation of the treatments were observed in either treatment group. The results of the invasive tests were evaluated by the end of the first month, and revealed an eradication rate of 88% in the sequential treatment group versus 95% in the ranitidine bismuth citrate treatment group. Sixty-eight of 94 patients in whom eradication was achieved by sequential therapy were reevaluated with H. pylori stool antigen test in one year, and eradication was found to persist in 52 (77%) of these 68 patients. Conclusions: High rates of eradication were achieved in both groups in the 4(th) week evaluation. It was observed at the follow-up performed one year later that the eradication achieved with sequential therapy persisted in 77% of the patients treated.

The pathogenesis of esophageal squamous papilloma is not fully open, but it is associated with esophagitis due to gastroesophageal reflux disease or Barrett's lesions and HPV infection. Esophageal squamous cell papillomas are usually located solitary and the distal esophagus. In this case multiple squamous cell papillomas of the esophagus is reported., Özofagusun benign bir lezyonu olan skuamoz hücreli papillomanın etyolojisi net değilse de gastroözofageal reflü hastalığına bağlı özofajit veya Barret lezyonuna bağlı kronik irritasyon ve human papilloma virus infeksiyonu ile ilişkilendirilmiştir. Özofagus skuamoz hücreli papilloması sıklıkla soliter ve distal yerleşimlidir. Bu olgumuzda tüm özofagusu tutan çok sayıda skuamoz hücreli papillomalar vardı.

Alt gastrointestinal kanama şüphesiyle kolonoskopi yapılan 61 yaşında kadın hastada sigmoid kolonda uzun saplı bir polip saptandı. Polipektomi yapılan hastada işlem sonrası ciddi arteriyel kanama olması üzerine işlem bölgesine acilen epinefrin ve sklerozan ajan uygulanarak kanama kontrolü sa¤landı. 3 saat sonra hastanın rektal kanamasının tekrarlaması üzerine kontrol kolonoskopide polip sapından kanamanın devam etti¤i gözlendi. Bunun üzerine polip sapına gastroskop ile endoskopik bant ligasyon uygulandı. Bu uygulama ile kanama başarılı bir şekilde durdurulabildi., A 61-year-old woman underwent colonoscopy to investigate lower gastrointestinal bleeding. A pedunculated polyp with a long stalk was identified in the sigmoid colon, and snare polypectomy was performed. Postpolypectomy arterial bleeding occurred after the resection, and the bleeding was stopped with immediate epinephrine and sclerosing agent injection. However, rectal bleeding started again three hours after polypectomy. In the repeat colonoscopic investigation, the site of the bleeding was confirmed at the stalk of the removed polyp. Endoscopic band ligation of the stalk was performed using a gastroscope and ligator instrument, and bleeding from the stalk was successfully controlled.

Endoskopik hemostaz metotları Mallory-Weiss Sendromuna ba¤lı üst gastrointestinal kanamalarda güvenli ve etkin bir yaklaşım olarak kabul edilmektedir. Kronik öksürü¤ü olan 62 yaşındaki bir erkek hasta ve 27 yaşında 10 haftalık gebe hasta klini¤imize ciddi hematemez bulgularıyla başvurdu. Bu hastalara üst gastrointestinal endoskopi uygulandı ve Mallory Weiss sendromu tanısı kondu. İşlem sırasında koagülum ve visible vessel görüldü ve bu lezyonlara argon plazma koagülasyonu uygulandı. Argon plazma koagülasyonu sonrasında tam bir kanama kontrolü sa¤landı ve takipte kanama tekrarlamadı. Sonuç olarak argon plazma koagülasyonu aktif kanayan non fibrotik Mallory-Weis sendromu olan hastalarda gecikmiş hemoraji ve perforasyon gibi minimal komplikasyon riskiyle kolaylıkla uygulanabilir., The endoscopic hemostatic method has been introduced as a safe and effective mechanical approach to hemostasis for upper gastrointestinal bleeding related to Mallory-Weiss syndrome. A 62-year-old male patient with chronic cough and a 27-year-old 10-week pregnant female were admitted to our clinic with gross hematemesis. Upper gastrointestinal endoscopy was performed and Mallory-Weiss syndrome was diagnosed. Coagulum and visible vessels were observed during the procedure. Argon plasma coagulation was applied. After argon plasma coagulation, complete hemostasis was achieved and rebleeding did not occur. In conclusion, argon plasma coagulation can be performed easily and with minimum risk of complications such as perforation or delayed hemorrhage in patients with actively bleeding non-fibrotic Mallory-Weiss syndrome.

Thrombophilic gene mutations have been reported to be associated with the formation of portal vein thrombosis (PVT). This study aimed to investigate the role of thrombophilic gene mutations in cirrhotic patients with PVT.A total of 74 cirrhotic patients (17 with PVT, 57 without PVT), and 19 non-cirrhotic patients with PVT and 80 healthy controls were included. Factor V Leiden G1691A, prothrombin G20210A and methylenetetrahydrofolate reductase C677T mutations were analysed by restriction fragment length polymorphism.Aetiologies and Child-Pugh distribution of cirrhotic patients with and without PVT were similar. Five of 17 (29%) of cirrhotic patients with PVT but only two of 57 (3.5%) of cirrhotics without PVT, five of 80 (6%) of controls and none of the 19 non-cirrhotic patients with PVT had factor V Leiden G1691A mutation (P0.05). Prothrombin G20210A mutation was found in five (29%) cirrhotic patients with PVT while only two (3.5%) cirrhotic patients without PVT, one (5%) non-cirrhotic patient with PVT and two (2.5%) controls had this mutation (P0.05). The frequency of the homozygote methylenetetrahydrofolate reductase 677C-T mutation was similar in all four groups.Inherited thrombophilic gene mutations appear to increase the risk of PVT formation in cirrhotic patients but not in patients without liver disease in a cohort of Turkish patients.

OBJECTIVE To evaluate the importance of fine needle aspiration cytology (FNAC) in the diagnosis of hepatocellular carcinoma (HCC). STUDY DESIGN We analyzed 17 cytologic and 5 architectural features in a series of 320 FNACs from HCC and compared them with 73 FNACs from benign lesions and with 705 FNACs from metastatic carcinomas. One thousand ninety-eight patients who were diagnosed by liver FNAC between December 1988 and July 1998 and had adequate follow-up were included in the study. The specimens were evaluated according to the presence or absence of the cytologic features and cellular arrangement. A stepwise logistic regression analysis was performed on the data to determine the variables predictive of HCC. RESULTS Multinucleated tumor giant cells, cytoplasmic hyaline and central sinusoidal pattern were selected as the 3 most predictive parameters for differentiated reactive hepatocytes from HCC (P < .0001), while bile, centrally located nucleus in an atypical cell and intranuclear inclusion were selected as the 3 most predictive parameters for differentiated metastatic carcinoma from HCC (P < .0001-< .001) by stepwise logistic regression analysis. CONCLUSION In the 1,098 patients suspected of having hepatic malignancy, a correct diagnosis was made by a combination of the above features. The sensitivity of this procedure for hepatic malignancy was 99.5%, and the specificity was 100%.

A number of disorders for which an association with hepatitis C virus infection exist. These disorders include essential mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and idiopathic pulmonary fibrosis. This study was initiated to investigate the cellular content and lymphocyte subpopulations of bronchoalveolar lavage fluid obtained from individuals with chronic hepatitis C and to compare the results to those of controls. Eighteen patients with chronic hepatitis C (male/female, 6/12) and 14 healthy volunteers (male/female, 6/8), were studied. Bronchoalveolar lavage fluid was obtained from each; and the lymphocyte subtypes and the presence of HCV-RNA in the bronchoalveolar lavage fluid were determined. All anti-HCV positive subjects were HCV-RNA positive in serum. One (5.6%) had a HCV-RNA positive bronchoalveolar lavage. The total cell and neutrophil counts of the bronchoalveolar lavage fluid were significantly greater in patients with chronic hepatitis C as compared to controls (5,799.6 ± 957.4 × 103/ml vs. 1,835.7 ± 447.8 × 103/ml, P = 0.001; 1,175.8 ± 634.7 × 103/ml vs. 53.1 ± 28.1 × 103/ml, P = 0.029). In contrast, the lymphocyte, macrophage and eosinophil counts did not differ. No difference in the percentage, median or range of individual T cell subsets or B cell numbers in the bronchoalveolar lavage fluid existed between the groups. It is concluded that hepatitis C virus infection may be associated with an occult pulmonary inflammatory reaction manifested by an increased number of polymorphonuclear neutrophils in bronchoalveolar lavage fluid. This finding may contribute to the process that leads to idiopathic pulmonary fibrosis seen in a minority of cases of chronic hepatitis C. J. Med. Virol. 66:34–39, 2002. © 2002 Wiley-Liss, Inc.

Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis.The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed.Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mmHg): (24 vs 20, p=0.033); median esophageal contraction amplitude (mmHg): (71 vs 56, p=0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p=0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p=0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient).Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.

To determine utility of proton density fat fraction (PDFF) measurements for quantifying the liver fat content in patients with nonalcoholic fatty liver disease (NAFLD), and compare these results with liver biopsy findings.This retrospective study was approved by the institutional review board with waivers of informed consent. Between June 2010 and April 2011, 86 patients received a diagnosis of NAFLD. Ten patients did not accept liver biopsy and six patients had contraindications for magnetic resonance (MR) imaging. Seventy patients were included in this study. Seventy patients with NAFLD (40 men, 30 women; mean age, 44.7 years; range, 16-69 years) underwent T1-independent volumetric multiecho gradient-echo imaging with T2* correction and spectral fat modeling. Median time interval between MR imaging and liver biopsy was 14.5 days (range, 0-259 days). MR examinations were performed with a 1.5-T MR imaging system. Complex-based PDFF measurements were performed by placing regions of interest in Couinaud system segments V-VI and all liver segments from I to VIII. All liver biopsy specimens were retrieved from archives and evaluated by one pathologist for hepatic steatosis according to criteria from a previous study. Pearson correlation coefficient, receiver operating characteristics, and linear regression analyses were used for statistical analyses.Mean PDFF calculated with MR imaging was 18.1% ± 9.5 (standard deviation). Close correlation for quantification of hepatic steatosis was observed between PDFF and liver biopsy (r = 0.82). PDFF was effective in discriminating moderate or severe hepatic steatosis from mild or no hepatic steatosis, with area under the curve of 0.95. The correlation between biopsy and PDFF-determined steatosis was less pronounced when fibrosis was present (r = 0.60) than when fibrosis was absent (r = 0.86; P = .02).PDFF measurement by MR imaging provided a noninvasive, accurate estimation of the presence and grading of hepatic steatosis in patients with NAFLD. Hepatic fibrosis reduced the correlation between biopsy results and PDFF.

Familial Mediterranean fever is an autosomal recessive disease characterized by recurrent fever and peritoneal and pleural inflammation. It is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. A small amount of peritoneal fluid collection can be observed during peritoneal attacks in patients with Familial Mediterranean fever, but chronic ascites has been described rarely in these patients. A 42-year-old female patient was admitted to our clinic in June 2010 with fever, severe abdominal pain and abdominal distention that had continued for one month. There was no family history of periodic fevers or abdominal pain. We could not find any cause for ascites, including tuberculosis. A diagnosis of Familial Mediterranean fever was suspected based on the clinical findings and her family history. She was screened for mutations causing Familial Mediterranean fever, and when found to be homozygous for M694V, treatment with colchicine was initiated. After treatment, the amount of ascites decreased, and relief of symptoms was confirmed during a follow-up. In conclusion, because Familial Mediterranean fever is common in our country, it should be considered in the differential diagnosis of patients with ascites of unknown etiology in populations where hereditary inflammatory disease is endemic.

Background/aims: Oral sodium phosphate is an agent used commonly in our country for cleaning the intestines before colonoscopy. Our aim was to compare the safety, tolerability and efficiency of oral sodium phosphate solution used in colonoscopy preparation in patients over 70 years of age. Methods: This study was carried out in Ankara University School of Medicine Cebeci Hospital Endoscopy Center between August 2008 and March 2009. The extent of colon cleanliness was scored in the colonoscopy procedure. The data from the two groups were compared. Results: In our study, 55 patients were divided into two groups according to their age, as over 70 years (n: 25) and under 70 years (n: 30). The average age of the group under 70 years was 49.4 +/- 9.8 and of the group over 70 years was 71.4 +/- 1.2 (p=0.04). Among the patients included in this study, 59.1% were female (n: 28) and 50.9% were male (n: 27). In the over 70 years group, the intestinal cleanliness was poor-fair in 2 patients, acceptable in 7 patients and excellent in 16 patients. In the below 70 years group, the intestinal cleanliness was poor in 2 patients, acceptable in 9 patients, good in 13 patients, and excellent in 6 patients. In the statistical evaluation, it was determined that there was no statistical difference between the over- and below 70 years of age groups regarding good-excellent intestinal cleanliness and poor-medium intestinal cleanliness (p=0.109). There was no statistical difference between the groups with regard to the adverse effects. The sodium, potassium and creatinine levels were assessed on the procedure day in 5 patients with clinical side effects (abdominal pain, nausea, vomiting, dizziness, hypotension) in the elderly group. No electrolyte imbalance or renal function impairment was observed in these patients. Conclusions: In the group of patients over 70 years old, a special patient group without comorbid diseases, oral sodium phosphate solution used for colon preparation was effective and well- tolerated with a low adverse effect rate. In spite of this safe profile, since serum creatinine levels and electrolyte imbalance were assessed in only a limited number of patients, the relationship reported in the literature between oral sodium phosphate and electrolyte imbalance and renal function impairment should be kept in mind.

Background and goals The aim of this cohort study was to determine the characteristics and clinical outcome of 170 patients with drug-induced liver injury (DILI) in a single center. Study Between January 2001 and June 2007, a total of 170 individuals who were diagnosed with DILI were retrospectively analyzed. The median follow-up period was 110.0 days. Results During the study period, a total of 5471 new patients were assessed for liver test abnormalities. Of those, 170 patients (3.1%) fulfilled the criteria of DILI. A total of 83 different drugs were considered to be related to the hepatotoxicity; a single drug was suspected in 57.6% of individuals. The median interval between the suspicious drug intake and DILI recognition was 15.0 days. Hepatocellular pattern was observed in 50.0% of patients with a mean alanine aminotransferase level of 952.2+/-907.0 U/L. The main causative group of drugs was antibiotics. Sixty-two patients required hospitalization; acute liver failure developed in 14 (8.2%), chronicity was observed in 19 (11.2%), and 7 died (4.1%). Overall, complete recovery occurred in 82% of patients. The presence of jaundice on admission and shorter interval period between drug intake and DILI recognition were identified as risk factors for the development of acute liver failure. Conclusions DILI is an important cause of liver test abnormalities in outpatient clinics, and antibiotics represent the most common drug group. Overall, complete recovery after the withdrawal of the suspicious drug occurred in the majority of patients, but DILI may progress to acute liver failure, chronicity, and death.

Background and Aims: Gastroesophageal reflux is the most frequent disease affecting the esophagus. The purpose of this study was to determine if there has been any change in esophagitis detection rates in recent years. Materials and Methods: All 63,854 upper gastrointestinal endoscopies performed at Ankara University, Gastroenterology Department, Ibn-i Sina and Cebeci Endoscopy Centers, between 1990 – 2008 were analyzed retrospectively. Grading for esophagitis was done using Savary – Miller Classification until 1999, after which the Los Angeles Classification was used. Age, sex, and other endoscopic findings like hiatal hernia, duodenal ulcer, bulbar deformity, gastric ulcer, pyloric stenosis, apical stenosis, gastric operations, gastritis, and alkaline reflux were recorded. Results: Of these 63,854 cases, 52.9% were women. The mean age was 46.75 (15-98). Esophagitis was detected in 10,275 (16.1%) cases. Severity was grade I in 61.9%, II in 26.5%, III in 8.1%, and IV in 3.4%. Esophagitis frequency and severity increased with age ( Giris Mide iceriginin ozofagusa gecmesi fizyolojik bir olaydir. Ozofagusa gecen mide iceriginin rahatsizlik yaratmasi veya ozofagus hasarina neden olmasina Gastroozofageal Reflu Hastaligi (GORH) denir. Gelisimindeki en onemli unsur reflu onleyici mekanizmalarin bozulmus olmasidir. Gastroozofageal Reflu Hastaligi toplumda sik gorulen, hayat kalitesini olumsuz etkileyen ve saglik sistemine giderek daha fazla yuk olan pahali bir hastaliktir (1, 2). Hastaligin seyrinde, Barret ozofagusu, hemoraji, striktur, perforasyon ve kanser gelisimi gibi ciddi komplikasyonlar gelistigi bilinmektedir. Yetiskinlerin %15-44'unde ayda bir, %20'sinde haftada bir, %7'sinde gunde bir kez reflu semptomlari goruldugu bildirilmistir. Bati toplumunda ust sindirim sistemi endoskopisi yapilan hastalarin %15-25'inde ozofajit bulundugu raporlanmistir. Asya'dan yapilan calismalarda ise bu sikligin %0.8-16.3 gibi cok daha az siklikta goruldugu bildirilmekte ve batililasmayla beraber sikligin giderek arttigi iddia edilmektedir (3). Son yillarda hem hekim ve hastalarin farkindaliginin artmasi ile daha fazla tani konmasi, hem de prevalansinda gercek bir artis oldugu bildirilmektedir. Gastroenterolojistlerin %90'i ve aile hekimlerinin %67'sinin gorusunun prevalansin arttigi yonunde oldugu bildirilmistir (4). Bu calismanin amaci ulkemizde yillar icinde ozofajit sikliginda degisiklik olup olmadigini degerlendirmektir. Gerec ve Yontem Ankara Universitesi Gastroenteroloji Bilim Dali Ibni Sina Hastanesi ve Cebeci Klinigi Endoskopi merkezlerinde 1990 – 2008 yillarinda yapilan 63854 ust gastrointestinal sistem endoskopisi sonucu retrospektif olarak degerlendirildi. Calismaya alinan vakalar, islem endikasyonu ve tekrar endoskopi olup olmamasi gozetilmeden alindi. Ozofajit derecelendirmesi 1999'a kadar Savary-Miller ve 1999`dan itibaren Los Angeles siniflamalarina gore yapilmisti (Tablo 1). Hastalarin yaslari, cinsiyeti ve ozofajite yandas endoskopik bulgulari (hiatus hernisi, duodenal ulser, bulbus deformitesi, gastrik ulser, pilor stenozu, apikal darlik, mide operasyonu, gastrit, safra gastriti, ozofagus ve mide kanseri) kaydedildi. Istatistik analizler icin SPSS 13.0 paket programi kullanildi. Anlamlilik degeri p

In patients with Budd-Chiari syndrome due to short segment hepatic vein stenosis where percutaenous transluminal venoplasty is not successful, percutaneous transhepatic balloon venoplasty may be a valid treatment option. The aim of this prospective study was to evaluate the effects of this procedure for the treatment of patients with Budd-Chiari syndrome, in whom transluminal cannulation was unsuccessful.Ten patients with short segment occlusion of the hepatic veins were treated by percutaneous transhepatic balloon venoplasty between January 1997 and January 2000. The median follow-up period of these patients was 20 months (2-33 months).The procedure was unsuccessful in two patients. Eight patients (five men, three women) with a median age of 28 (range, 15-61) years were treated by percutaneous transhepatic balloon venoplasty and in seven of them, clinical symptoms including abdominal distension and ascites, resolved completely. Long term anticoagulation therapy was not given to the patients. One patient with advanced stage liver disease died of variceal bleeding two months after the procedure. During follow-up, symptomatic reocclusion requiring dilatation occurred in three patients.Percutaneous transhepatic balloon venoplasty is an alternative treatment option for selected patients with Budd-Chiari syndrome when transluminal cannulation of the hepatic veins is not possible. Long term anticoagulation therapy seems to be necessary in these patients.

Fine needle aspiration biopsy is a useful tool in the diagnosis of primary malignancies and metastatic lesions of the liver. The aim of this study was to determine the types and features of tumors diagnosed by this method and the difficulties in differential diagnosis.Fine needle aspiration biopsy smears from 704 patients with metastatic liver lesions were reviewed.Among the metastastatic carcinomas in which their primary origin was identified, pulmonary carcinomas were the largest group. While colon adenocarcinoma was most prevalent (21.65%) where the primary origin of metastatic tumors was identified, followed by breast carcinoma (20.10%) and gastric adenocarcinoma (19.59%). The cases which cannot be differentiated from hepatocellular carcinoma in cytologic examination are invasive ductal carcinoma, renal cell carcinoma and squamous cell carcinoma.Pulmonary and colon carcinomas are the common metastatic tumors of the liver.

To evaluate the importance of fine needle aspiration cytology (FNAC) in the diagnosis of hepatocellular carcinoma (HCC).We analyzed 17 cytologic and 5 architectural features in a series of 320 FNACs from HCC and compared them with 73 FNACs from benign lesions and with 705 FNACs from metastatic carcinomas. One thousand ninety-eight patients who were diagnosed by liver FNAC between December 1988 and July 1998 and had adequate follow-up were included in the study. The specimens were evaluated according to the presence or absence of the cytologic features and cellular arrangement. A stepwise logistic regression analysis was performed on the data to determine the variables predictive of HCC.Multinucleated tumor giant cells, cytoplasmic hyaline and central sinusoidal pattern were selected as the 3 most predictive parameters for differentiated reactive hepatocytes from HCC (P.0001), while bile, centrally located nucleus in an atypical cell and intranuclear inclusion were selected as the 3 most predictive parameters for differentiated metastatic carcinoma from HCC (P.0001-.001) by stepwise logistic regression analysis.In the 1,098 patients suspected of having hepatic malignancy, a correct diagnosis was made by a combination of the above features. The sensitivity of this procedure for hepatic malignancy was 99.5%, and the specificity was 100%.

Mitochondrial neurogastrointestinal encephalomyopathy is a rare, multisystem disorder characterized by gastrointestinal dysmotility, ptosis, neurologic findings (e.g., peripheral neuropathy), leukoencephalopathy, and thin body habitus. Gastrointestinal motility studies and skeletal muscle biopsy are recommended diagnostic tools. We report two patients that highlight the diagnostic characteristics of this rare entity.

A number of disorders for which an association with hepatitis C virus infection exist. These disorders include essential mixed cryoglobulinemia, membranoproliferative glomerulonephritis, and idiopathic pulmonary fibrosis. This study was initiated to investigate the cellular content and lymphocyte subpopulations of bronchoalveolar lavage fluid obtained from individuals with chronic hepatitis C and to compare the results to those of controls. Eighteen patients with chronic hepatitis C (male/female, 6/12) and 14 healthy volunteers (male/female, 6/8), were studied. Bronchoalveolar lavage fluid was obtained from each; and the lymphocyte subtypes and the presence of HCV-RNA in the bronchoalveolar lavage fluid were determined. All anti-HCV positive subjects were HCV-RNA positive in serum. One (5.6%) had a HCV-RNA positive bronchoalveolar lavage. The total cell and neutrophil counts of the bronchoalveolar lavage fluid were significantly greater in patients with chronic hepatitis C as compared to controls (5,799.6 +/- 957.4 x 10(3)/ml vs. 1,835.7 +/- 447.8 x 10(3)/ml, P = 0.001; 1,175.8 +/- 634.7 x 10(3)/ml vs. 53.1 +/- 28.1 x 10(3)/ml, P = 0.029). In contrast, the lymphocyte, macrophage and eosinophil counts did not differ. No difference in the percentage, median or range of individual T cell subsets or B cell numbers in the bronchoalveolar lavage fluid existed between the groups. It is concluded that hepatitis C virus infection may be associated with an occult pulmonary inflammatory reaction manifested by an increased number of polymorphonuclear neutrophils in bronchoalveolar lavage fluid. This finding may contribute to the process that leads to idiopathic pulmonary fibrosis seen in a minority of cases of chronic hepatitis C.