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Background: Thrombosis in the portal system causes a wide spectrum of clinical pictures. There are few published studies describing the clinical features and consequences of portal venous system thrombosis. We aimed to document presentations and outcomes in patients with thrombosis in the portal and/or splenic veins. Patients and Methods: The study included 95 patients who were diagnosed with portal venous system thrombosis in the period September 2001 to April 2006. Demographics, clinical presentation, diagnostic investigation, management, morbidity, and mortality were recorded in their follow-up. Results: Of the 95 patients with portal vein thrombosis (PVT), 35 had isolated PVT (IPVT), 27 had isolated splenic vein thrombosis (ISVT), and 33 had thrombosis in both the portal and splenic veins (PSVT). The mean follow-up periods after diagnosis of IPVT, ISVT, and PSVT were 36, 31, and 32 months, respectively. Abdominal pain and gastrointestinal bleeding were the most common symptoms at presentation in the IPVT and PSVT groups, whereas abdominal pain was the dominant symptom in the ISVT group. During the follow-up period, no bleeding was seen in 26 of the 35 (74%) patients with IPVT, in 23 of the 33 (70%) patients with PSVT, and in 24 of the 27 (89%) patients with ISVT. Biliopathy developed during follow-up in 11 of 35 patients with IPVT, in 1 of 27 with ISVT, and in 5 of 33 with PSVT. In the ISVT group, there were 11 deaths, and one each in the IPVT and PSVT groups. Conclusions: The etiology of PVT varies in portal and splenic veins. IPVT has a higher morbidity (bleeding and portal biliopathy), whereas ISVT that is not associated with an underlying malignancy has a favorable prognosis.

Our aim was to analyze patients diagnosed with left-sided portal hypertension prospectively and to document the complications at follow-up. Twenty-four patients with isolated splenic vein thrombosis (diagnosed by ultrasonography or angiography or intraoperatively) and/or isolated fundal varices (diagnosed by endoscopy or endosonography) were involved in this study. Demographics, clinical presentation, diagnostic and therapeutic procedures, and morbidity and mortality were recorded in their follow-up. There were 11 and 13 left-sided portal hypertension cases associated with pancreatic diseases and nonpancreatic disorders, respectively. Chronic abdominal pain and gastrointestinal bleeding were the two most common complaints. All patients except one had isolated esophageal (2 cases) or fundal (21 cases) varices. Thirteen patients had splenomegaly on ultrasonography. On Doppler sonography, the splenic vein could be evaluated in 21 of the 24 patients (9 and 6 had complete and partial occlusion, respectively, and 6 had patent blood flow). Urgent intervention with therapeutic endoscopy and splenectomy was performed for two patients each. Medical therapy was begun for three patients according to the underlying diseases. Three patients underwent elective surgery. Two patients were lost to follow-up after the first visit and the mean follow-up of the remaining 22 patients after diagnosis of left-sided portal hypertension was 20 months. Only one patient (with pancreas cancer) had gastrointestinal bleeding at follow-up. All patients with pancreas and gastric cancer died within 2-12 months. Left-sided portal hypertension has various etiologies. It may be difficult to diagnose this entity both endoscopically and radiologically. Treatment should be directed at the underlying diseases. Recurrent hemorrhage due to left-sided portal hypertension is not usual and the prognosis depends mainly on the underlying etiology.

Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC. © 2014 Informa UK Ltd.

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.

Recently, the existence of a local renin angiotensin system (RAS) in the pancreas has been demonstrated in laboratory animals as well as in human. It has been suggested that RAS and angiotensin converting enzyme (ACE) activity increase in diseases involving pancreas tissue. In the present study, we analyzed the relationship between serum ACE levels and pancreas disorders including acute and chronic pancreatitis, and pancreas adenocancer.The study groups comprised 14 cases with acute pancreatitis (male/female: 5/9), 38 chronic pancreatitis patients (male/female: 25/13) and 21 pancreas adenocancer cases (male/female: 11/10). The ACE activity in the sample was determined by comparing the sample reaction rate to that obtained with the ACE calibrator.Serum ACE levels were 38.28 +/- 23.67 U/L (10-108), 43.71 +/- 23.58 UL (7-120), 39.14 +/- 19.31 U/L (5-77) and 38.04 +/- 13.69 U/L for patients with acute pancreatitis, chronic pancreatitis, pancreas cancer and healthy controls respectively. Serum ACE levels were not significantly different among all groups (p0.05). There was no significant difference regarding ACE levels in patients with metastasis and without metastasis. There was no correlation between ACE levels and tumor size.Our results showed that serum ACE levels increased in neither benign nor malignant pancreas diseases. However, serum ACE levels may not reflect the actual RAS activity because non-ACE pathways affecting RAS activity have been described. Further studies analyzing non-ACE pathways contributing to RAS activity in human pancreatic disorders are needed.

This Case Study discusses a 57-year-old male diagnosed with an aortoenteric fistula secondary to aortic graft surgery. The case highlights the importance of performing multidetector CT as soon as possible in patients who are suspected to have this condition so a quick diagnosis can be made. Background A 57-year-old male with an aortobifemoral bypass graft presented to a gastroenterology clinic with a 3-month history of intermittent hematemesis, melena and fever. The patient had received antibiotic therapy 2 months before for the same symptoms; however, following brief regression (∼3 weeks) the symptoms had returned. Investigations Physical examination; analysis of full blood count; measurement of erythrocyte sedimentation rate, C-reactive protein levels, liver enzymes, electrolytes, renal function, serum cholesterol and serum triglyceride; HIV serology; blood, sputum, urine and stool culture analysis; performance of esophagogastroduodenoscopy, colonoscopy, abdominal ultrasonography and multidetector CT scanning. Diagnosis Aortoenteric fistula with an inflammatory mass surrounding the aortobifemoral bypass graft. Management Laparotomy with removal of the aortobifemoral bypass graft, performance of an extra-anatomic right axillofemoral bypass graft and an extra-anatomic right-left femorofemoral bypass graft.

Autosomal-dominant polycystic kidney disease is an inherited disorder characterized by multiple cysts in kidneys and other organs. A 63-year-old man was evaluated for the etiology of recurrent pancreatitis and chronic renal failure. Multiple cysts of kidneys, liver, and pancreas and pancreas divisum was diagnosed. Pancreatitis should be included in the differential diagnosis of abdominal pain in patients with ADPKD. Pancreas divisum may be a predisposing factor for acute pancreatitis in these patients.

In childhood, a significant proportion of giant aneurysms usually occur at the vertebrobasilary system. Nonetheless, giant totally thrombosed aneurysm which only involves the vertebral portion of the vertebrobasilary system is very rare. Up to this time, in childhood, a few giant aneurysm originating from vertebral artery have been reported, and to our knowledge only one case was reported to be totally thrombosed. The enlargement tendency of totally thrombosed aneurysms and management of these cases are still controversial. Thus, diagnosis and follow-up of cases where a radical approach could not be performed require a multi-modality radiologic approach. In this study, we reported a case of angiographically occult giant thrombosed vertebral artery aneurysm, which is extremely rare, and discussed the importance of CT and MRI in evaluation of these patients before surgical treatment. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.