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Introduction: Chronic inflammatory diseases (CIDs) are lifelong complex disorders that affect quality of life, and this study aimed to summarize 5 years of experience with a multidisciplinary approach for these complex diseases as a result of medical council meetings. Methods: Hospital-based, medical records review study was conducted. A total of 45 monthly medical council meetings were held between 2014-2019 with the participation of the rheumatology, dermatology and gastroenterology departments of the same university. Patients with complex conditions that were seen in each department's own polyclinic composed the council. This study only included 308 patients referred by the rheumatology group. Results: Females made up 66.5 % of the 308 patients. The median age was 45 (19-77). PsA (psoriatic arthritis) and other SPA (spondyloarthritis) patients composed 49.3% of the total. A total of 68.18% of the patients were presented only to consult with the dermatology department. The most common reason for presenting patients was to discuss options for treatment (41.5%). The diagnosis of psoriasis was confirmed in 48 of 67 (71.6%) patients who presented with a pre-diagnosis. The diagnosis was changed in 34.74% of the patients, whereas the diagnosis became completely different in 11.36% of the patients. Conclusions: Many patients with challenging diagnosis and treatment processes are encountered in daily practice. The combination of different disciplines makes it possible to provide more rapid and effective solutions. In this study, we aimed to emphasize the increasing importance of such multidisciplinary approaches

Wilson disease is an inherited disorder that results in copper accumulation in the tissues with liver injury and failure. Orthotopic liver transplant is one of the treatments of choice for this disease. The aim of this study was to compare the neurological symptoms, before and after orthotopic livertransplant, of patients with liver cirrhosis due to Wilson disease, who represent a special group of patients with liver failure.Between 2007 and 2020, there were 24 patients with Wilson disease resistant to medical treatment who underwent deceased donor orthotopic livertransplant and were followed up for 1 year, 5 years, and 10 years for evaluation with neurological scoring systems. Patients were also evaluated for postoperative complications and survival.Of the 24 patients evaluated, there were 13 (54.2%) female patients and 11 (45.8%) male patients, and the mean age was 34 years (range, 14-57 years). One of the patients died from early postoperative sepsis. After orthotopic livertransplant, disease scores returned to normal in 16 patients and improved in the remaining patients. Before transplant, all patients required help in their daily activities. After transplant, there were significant improvements in some symptoms, and the patients became more independent in their daily lives.Our study shows that orthotopic liver transplant provides significant improvement in neurological symptoms and quality of life in patients with Wilson disease.

The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t) ide analogs after liver transplantation.

Background We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH., Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic), A. Gerussi, L. Cristoferi, and P. Invernizzi acknowledge that this research was partially supported by the Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic).

We report a case of neurotoxicity as a side effect of a calcineurin inhibitor (tacrolimus), which is used as an immunosuppressive drug after liver transplant. Our patient had chronic hepatic failure due to Budd-Chiari syndrome and underwent a liver transplant after an appropriate deceased donor organ was obtained. After organ transplant surgery, he was kept under the effect of an immunosuppressive drug (tacrolimus) with daily control of the level of drug in his blood to avoid drug toxicity. Despite the level of drug in his blood being within the ideal range, the patient developed neurotoxicity that presented as weakness of his extremities. Appropriate diagnostic tests were done, and all proved that these signs and symptoms were related to the use of tacrolimus. Therefore, the drug was changed to cyclosporine. After a few months, the patient regained normal neurological functions of his extremities. We should take precautions to monitor neurological symptoms and signs while we administer calcineurin inhibitors.

Background: data regarding outcome of Coronavirus disease 2019 (COVID-19) in patients with autoimmune hepatitis (AIH) are lacking. Patients and methods: we performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated. Results: we included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe COVID-19 (15.5% vs 20.2% p=0.231) and all-cause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p, Italian Ministry of University; Research (MIUR)-Department of Excellence Project PREMIA; AMAF Monza ONLUS; AIRCS

Background and Aim: The prevalence and clinical significance of extrahepatic autoimmune diseases (EHAIDs) have not been evaluated in a large cohort of primary biliary cholangitis (PBC). Methods: The medical records of 1554 patients with PBC from 20 international centers were retrospectively reviewed. Development of decompensated cirrhosis (ascites, variceal bleeding, and/or hepatic encephalopathy) and hepatocellular carcinoma were considered clinical endpoints. Results: A total of 35 different EHAIDs were diagnosed in 440 (28.3%) patients with PBC. Patients with EHAIDs were more often female (92.5% vs 86.1%, P&nbsp

“Transplantasyon’16” Kongre’sinde poster bildiri olarak sunulmuştur (13-15 Ekim 2016, Konya). Bu çalışmada Bursa Uludağ Üniversitesi Tıp Fakültesi’nde değerlendirilen ve karaciğer nakli yapılan hastalardaki latent tüberküloz sıklığını ve tedavi durumlarını incelemeyi amaçladık. Son 2 yıl içerisinde karaciğer nakli amacıyla başvuran 16’sı kadın 60 hasta çalışmaya alındı. Yaş ortalaması 53,8 idi. Olguların değerlendirmesinde 39 olguda tüberkülin cilt testi (TCT) 5 mm ve üzerinde pozitif olarak değerlendirildi. Olguların 25’inde karaciğer nakli gerçekleşmişti. Bütün olgular Göğüs Hastalıkları Anabilim Dalı tarafından değerlendirilerek TCT pozitif olan olgulara izoniyazid profilaksisi önerildi. Tedavi önerilen olguların sadece 3 tanesinin ilacını kullandığı saptandı. Latent tüberküloz tedavisi başlanılması önerilen olguların sadece %8’inin tedavi aldığını saptadık. Latent tüberküloz tedavisi karaciğer nakli olan hastalarda TCT pozitifliği saptanması durumunda rehberler tarafından kuvvetle önerilmektedir. Olgularımızda bu çalışmayı yaparak uyum oranının çok düşük olduğunu saptadık. Düzenli takiplere gelen bu hastaların profilaksi tedavisini kullanmaları yönünde değerlendirilmesi gerekmektedir. We aimed to investigate the incidence and treatment status of latent tuberculosis in patients who underwent liver transplantation at Bursa Uludag University School of Medicine. Sixty patients (16 female) who were admitted for liver transplantation in the last 2 years were included in the study. The mean age was 53.8 years. Tuberculin skin test (TST) in 39 cases was found to be positive or greater than 5 mm. Liver transplantation was performed in 25 patients. All cases were evaluated by the Department of Chest Diseases and isoniazid prophylaxis was recommended to the patients who were positive for TST. It was determined that only 3 of the patients were treated with medication. We found that only 8% of the patients recommended to receive latent tuberculosis treatment. Latent tuberculosis treatment is strongly recommended by the guidelines in the presence of TST positivity in patients with liver transplantation. In this study, we found that the compliance rate was very low. Prophylaxis treatment should be considered in these patients who attend regular follow-up.

EgeUn###, INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.

Background/Aims: To investigate the relationship between gamma-glutamyl transpeptidase (GGT) levels and histopathological status determined by biopsy in patients with chronic hepatitis B and C. Materials and Methods: Patients with chronic hepatitis B and C who were referred to the Uludag University Faculty of Medicine Gastroenterology outpatient clinic between January 2005-January 2011 and underwent liver biopsy were included in the study. Overall, 246 patients with hepatitis B and 151 patients with hepatitis C were enrolled. According to the evaluation based on the Ishak score, patients with a histological activity index (HAI) between 0-12 were defined as low activity, and those with an HAI between 13-18 were defined as high activity. In addition, patients with a fibrosis score of 0-2 were defined as low fibrosis, and those with a score between 3-6 were defined as high fibrosis; comparisons were made accordingly. Results: In patients with hepatitis B, the mean GGT level was 38.86 +/- 42.4 (IU/L) in the low activity group and 60.44 +/- 44.4 (IU/L) in the high activity group (p

Amac: Bu calismanin amaci high-grade displazi (HGD) ve invaziv kanser ( “ilerlemis patoloji (IP)” olarak tanimlanmistir) ile iliskili multipl hasta ve adenom karakterlerini degerlendirmektir. Materyal ve Metod: Toplam 6250 islem sonunda 894 hastada 1379 (% 22.06) polip mevcuttur. Biz patoloji sonuclarina ulasabildigimiz 914 polipi degerlendirmeye aldik. Bulgular: 914 polipte toplam 699 adenom tespit edildi. A total of 699 adenomas were detected from 914 polyps. Sag kolon yerlesimli poliplerde sola gore daha yuksek oranda IP ozellikleri bulundu (% 18.5 vs % 7.1 p: 0.002). Lojistik regresyon analizi sonucunda; erkek cinsiyet, 2 cm’e esit ya da buyuk boyut, villoz histoloji ve non-dimunitif gorunum adenomlardaki IP ozellikleri icin bagimsiz risk faktorleri olarak bulundu. Sonuc: Calismamizda, diger calismalara benzer olarak, erkek cinsiyet, 2 cm’e esit ya da buyuk boyut, villoz histoloji ve non-dimunitif gorunum adenomlardaki IP ozellikleri icin bagimsiz risk faktorleri olarak bulundu. Fakat diger bircok calismanin aksine biz sag kolon yerlesimli poliplerde sol taraf yerlesimli poliplere gore daha yuksek oranda IP ozellikleri bulduk.

Wandering spleen is the displacement of the spleen from its normal location due to the loss or weakening of ligaments that hold the spleen in the left upper quadrant. The possibility of torsion of the spleen is high due to the long and mobile nature of the vascular pedicle. Generally, cases are asymptomatic. Under conditions of delayed diagnosis, symptoms of splenomegaly, left portal hypertension, gastric fundal varices, and hypersplenism. may present as a result of development of vascular congestion associated with chronic torsion. There are only a few cases in the literature reporting the association of wandering spleen and fundal vat-ices. We report herein the case of a 55-year-old female who admitted to our clinic with complaints of fatigue and epigastric pain. She was determined to have gastric fundal varices and hypersplenism secondary to the development of left portal hypertension due to chronic splenic torsion.

Background: It has been recently reported that serum paraoxonase (PON1) and arylesterase (ARE) activities may be significantly reduced in patients with chronic liver disease. The aim of the study was to investigate the relations between serum PON1 and ARE activities and the degree of liver damage in patients with chronic liver injury. Methods: We studied a total of 75 patients with chronic liver disease (50 patients with cirrhosis and 25 patients with chronic hepatitis) and 25 healthy comparison subjects. Baseline and salt-stimulated PON1 and ARE activities were determined in all study participants. Results: Baseline and stimulated PON1 and ARE activities were significantly lower in patients with chronic liver disease than in controls. Cirrhotic patients in Child–Pugh classes B and C subgroups had significantly reduced PON1 and ARE activities compared with Child–Pugh class A patients (both P-values

WOS: 000364330100001 PubMed: 26352130 Background and aim Noninvasive tests are primarily used for staging hepatic fibrosis in patients with chronic liver disease. In clinical practice, serum aminotransferase levels, coagulation parameters, and platelet count have been used to predict whether or not a patient has cirrhosis. In addition, several studies have evaluated the accuracy of combinations (or ratios) of these measures. The present study aimed to investigate the relationship between five noninvasive models [AST/ALT ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), age-platelet index (APind), and King's score] and the degree of hepatic fibrosis as determined by biopsy in patients with chronic hepatitis B and C. Patients and methods A total of 380 patients with viral hepatitis (237 with chronic hepatitis B and 143 with chronic hepatitis C) who were seen at our clinic between January 2005 and January 2011 were retrospectively analyzed. The degree of fibrosis was determined using the Ishak score. Patients with a fibrosis score of 0-2 were considered to have low fibrosis and those with a score between 3 and 6 were considered to have high fibrosis. Five noninvasive models were compared between the groups with low and high fibrosis. Results There were statistically significant differences between the hepatitis B and C patients with high and low fibrosis with respect to APind (4.492.35 vs. 2.41 +/- 1.84; P

To determine the effect of marginal donor livers on mortality and graft survival in liver transplantation (LT) recipients. Materials and methods: Donors with any 1 of following were considered marginal donors: age =>65 years, sodium level =>165 mmol/L and cold ischemia time =>12 h. Donors were classified according to the donor risk index (DRI) 1.7. The transplant recipients' model for end-stage liver disease (MELD) scores were considered low if 20. Early graft dysfunction (EGD) and mortality rate were evaluated. Results: During the study period 47 patients underwent cadaveric LT. The mean age of the donors and recipients was 45 years (range: 5¬-72 years) and 46 years (range: 4-66 years), respectively. In all, there were 15 marginal donors and 18 donors with a DRI >1.7. In total, 4 LT patients that received livers from marginal donors and 5 that received livers from donors with a DRI =>1.7 had EGD. Among the recipients of marginal livers, 5 died, versus 4 of the recipients of standard livers. There was no significant difference in EGD or mortality rate between the patients that received livers from marginal donors or those with a DRI =>1.7 and patients that received standard donor livers. Conclusion: Marginal and DRI =>1.7 donors negatively affected LT outcomes, but not significantly.

USLAN, MUSTAFA IHSAN/0000-0002-8890-8026 WOS: 000367668900008 PubMed: 26759574 Background: The mean platelet volume (MPV) is the most commonly used measure of platelet size and is a potential marker of platelet reactivity. In this study, we aimed to explore the relationship between hepatic histopathology in viral hepatitis and MPV levels, which are associated with platelet count and activity. Materials and Methods: We performed a retrospective case-control study of baseline histological and clinical parameters in chronic hepatitis B and C patients in our tertiary reference center between January 2005 and January 2011. Two hundred and five chronic hepatitis B patients and 133 chronic hepatitis C patients who underwent liver biopsy were included in the study. The patients were divided into two groups: Chronic hepatitis B and chronic hepatitis C and were additionally divided into groups of two according to histological activity index (HAI) and fibrosis scores obtained by liver biopsy results (according to the Ishak scoring system). The clinical characteristics of chronic viral hepatitis patients, including demographics, laboratory (especially MPV), and liver biopsy findings, were reviewed. Results: One hundred and forty-three patients were male (69.1%), and the mean age was 41.9 +/- 12.75 with an age range of 18-71 years in hepatitis B patients. In the classification made according to HAI, 181 patients were in the low activity group (88.3%) and 24 in the high activity group (11.7%). In the evaluation made according to fibrosis score, 169 patients were found to have early fibrosis (82.4%) and 36 were found to have advanced fibrosis (17.6%). In patients with hepatitis B, there was no statistically significant difference in terms of their MPV values between the two groups, separated according to their degree of activity and fibrosis. Sixty-three patients were male (47.3%), and the mean age was 50.03 +/- 12.75 with an age range of 19-75 years. In the classification made according to HAI, 109 patients were in low activity group (81.9%) and 24 in high activity group (18.1%). In the evaluation made according to fibrosis score, 101 patients were found to have early fibrosis (75.9%) and 32 have advanced fibrosis (24.1%). There was a statistically significant difference between the activity and fibrosis groups of the hepatitis C patients (P = 0.04 and P = 0.02, respectively). Conclusion: MPV values are more reliable in hepatitis C patients than hepatitis B for predicting the advanced damage in liver histology. This finding might be useful for the detection of early fibrosis and also starting early treatment, which is important in hepatitis C.

Background Apoptosis may be defined as programmed cell death. It is involved in the normal development and homeostasis of tissues in multicellular organisms. An increased or decreased rate of apoptosis may lead to a range of diseases. Fas antigen is a cell-surface receptor that induces apoptotic pathways when treated with Fas ligand or anti-Fas antibody. There is increasing evidence that apoptosis plays an important role in the immunopathogenesis of chronic viral hepatitis, in which the Fas antigen-Fas ligand pathway is particularly involved. Methods Fas antigen expression and apoptosis (apoptotic index) were assayed using flow cytometry in the hepatocytes of 27 patients with chronic viral hepatitis. Histopathological activity, scored by Knodell's histological activity index, other histopathological parameters, serum transaminase values and patient age were then compared with apoptotic index and Fas antigen expression. Results Apoptosis and Fas antigen expression in hepatocytes were correlated closely with histological activity (grade) Of chronic viral hepatitis, but there were no correlations with histological stage, patient age or serum transaminase levels. Conclusion Apoptosis and its triggering molecule, Fas antigen, induce mechanisms that appear to be associated with the pathogenesis of chronic viral hepatitis.

Amaç: Siroz hastalarında portal hipertansiyona bağlı olarak gelişen özefagus varis kanamaları (ÖVK), çok önemli bir mortalite nedenidir. Buna rağmen, varis kanamasının sekonder profilaksisine yönelik, birbirleri ile çelişen sonuçlar mevcuttur. Bu çalışmada varis kanamalarının tekrarının önlenmesi için kullanılan yöntemlerin klinik etkinliği ve sağkalım süreleri üzerine olan etkileri araştırılmıştır. Yöntem : Çalışmamızda siroz teşhisi konulmuş ve özefagus varis kanaması geçiren 180 hasta incelendi. Bu hastalar profilaksi almış olanlar ve profilaksi almamışlar olarak iki gruba ayrıldı. Profilaksi başlanmış olan hastalar da kullandıkları tedavi modalitesine göre 7 alt gruba ayrıldı. Bu hastalarda sağkalım süreleri, mortalite oranları ve profilaksiden sonra kanama rekürrensi değerlendirildi. Bulgular: Çalışmaya alınan hastaların 133 tanesine profilaksi başlanmış olup, bu hastaların gastroskopilerindeki varislerin derecesinin artması ile sağkalım sürelerinin kısaldığı belirlendi. Hastaların Child evreleri de sağkalım süreleri ile doğrudan ilişkiliydi ve tedavinin başlangıcında Child derecesi yüksek olarak tespit edilen hastaların yaşam süreleri daha kısaydı. Profilaksi başlanan hastalarda mortalite oranları anlamlı derecede daha düşük, sağkalım süreleri ise belirgin olarak daha uzundu. Yaşam süresi dikkate alındığında; tedavi gruplarında en iyi başarı, beta -bloker + bant ligasyonu tedavisi ile elde edildi. Sonuç : Bizim çalışmamızın sonuçları, ÖVK geçi ren hastalarda, sekonder profilaksinin, olumlu ve yararlı etkilerini yansıtmaktadır. Beta -bloker tedavisi ile alınan olumlu sonuçlar, bu grubun profilaksideki etkinliğinin bir göstergesi olarak düşünülebilir. Ayrıca beta -blokerlerin bant ligasyonu ile birl ikte kullanıldığında elde edilen yüksek klinik başarı, profilakside kullanılan medikal tedavilerin, girişimsel endoskopik yöntemlerle kombine edilmesinin, hastalar için daha yararlı olduğunu düşündürmektedir. Objective : Esophageal variceal bleeding (EVB) due to portal hypertension in cirrhotic patients is very important because of mortality. There were contradicted results in secondary prophylaxis for variceal bleeding. In this study our primary aim is to investigate that methods to prevent variceal rebleeding are really efficacious and to establish different treatment methods clinical success. Our secondary aim is to determine of effective factors on survival period. Method : One hundred eighty patients with established cirrhosis disease and had vari ceal bleeding enrolled in this study. Patients divided into two groups as they had prophylaxis or not. Patients in the prophylaxy group were divided into seven subgroups. Survival periods, mortality proportions, and bleeding recurrency after prophylaxis are evaluated as treatment success. The factors which influenced patients treatment success are investigated. These groups evaluated clinically and compared with each other statistically. Results : We started prophylaxis to one hundred thirty three of the patients enrolled and we determined survival periods of these patients decreased by their variceal grades are increased in endoscopies. Child grades of patients are related to survival periods, while the patients grade was increasing, survival period was decreasing. In the prophylaxy group, mortality proportions were significantly increased. In regard to survival period, best success in treatment groups has acquired with beta -blocker plus band ligation treatment. Conclusion : We concluded that, with our study results, secondary prophylaxis has advantage and is essential in patients who had EVB. The positive results achieved with beta -blocker treatment can be accepted as this groups activity and success in prophylaxis. Moreover the high clinical success with beta -blocker plus band ligation is suggesting medical treatments combination with invasive endoscopy methods are more useful for patients.

Caspase-cleaved cytokeratin 18 (CK18-Asp396) is released from hepatocytes during apoptosis. Recent studies have indicated that serum levels of CK18-Asp396 could be a clinically useful biomarker of chronic liver disease. To shed more light on the rate of hepatocyte loss by apoptosis in chronic liver disease, serum levels of CK18-Asp396 were examined in patients with nonalcoholic steatohepatitis (NASH) and chronic hepatitis C.Apoptotic CK18-Asp396 levels were quantified in sera from 35 patients with nonalcoholic steatohepatitis (NASH), 21 patients with chronic hepatitis C (HCV), and 18 healthy controls.Analysis of serum CK18-Asp396 levels showed an increasing trend starting from healthy controls (median: 54.5 U/l), to HCV patients (80.1 U/l), to patients with NASH (144.1 U/l, Kruskall-Wallis test: P0.001). Post hoc analyses revealed that CK18-Asp396 levels were significantly higher in the NASH patients than in both HCV patients (P=0.008) and healthy controls (P0.001). Moreover, the levels were significantly higher in patients with HCV than in control individuals (P0.05). In patients with chronic HCV infection there was a significant positive correlation between serum CK18-Asp396 levels and AST (r=0.442, P0.05), the ultrasonographic grade of steatosis (r=0.446, P0.05), and the histological steatosis score (r=0.759, P0.001).Although subject to future confirmation, these pilot findings seem to indicate that serum levels of caspase-cleaved cytokeratin 18 (CK18-Asp396) are higher in patients with NASH than in those with chronic HCV infection. These data suggest that NASH patients have an increased hepatocyte loss by apoptosis compared with chronic hepatitis C patients.

We report on a 43-year-old female patient with multiple thrombotic risk factors who, in a few months, developed acute myocardial infarction, an ischemic cerebrovascular event and variceal bleeding due to portal vein thrombosis. The factor V Leiden mutation was carried in heterozygous form, homocysteine was elevated at 19.6 micromol/l, and methylenetetrahydrofolate reductase C677T mutation was carried in homozygous form. Moderately increased plasma homocysteine level and a reduced protein S activity were evident. Anticardiolipin IgG antibodies were mildly positive. We conclude that the presence of multiple genetic and environmental risk factors greatly amplifies the risk of clinical thrombotic events.

AIM: To investigate serum alanine aminotransferase (ALT) levels in relation to the clinical, biochemical, ultrasonographic and histological characteristics of patients with hepatitis C virus. METHODS: Duration of disease, HCV-RNA, liver steatosis, and the hepatitis activity index (HAI) were correlated with serum ALT in 36 patients with HCV. ALT values were also investigated in 16 control subjects without any liver diseases. RESULTS: In bivariate analyses, ALT levels correlated with duration of HCV infection (P < 0.01), HCV-RNA (P < 0.05), and the HAI (P < 0.01). Among the components of the HAI, ALT concentrations were significantly associated with periportal bridging/necrosis (P < 0.01) and fibrosis (P < 0.05). In multivariate analysis, periportal bridging/necrosis (β = 0.508; P < 0.01), duration of HCV infection (β = 0.413; P < 0.01), and HCV-RNA (β = 0.253; P < 0.05) were independently associated with ALT activity. The normal ALT activity for men and women was < 23 IU/L and < 22 IU/L, respectively. CONCLUSION: In patients with HCV, alterations in the liver tissue as reflected by ALT elevation are mainly associated with periportal bridging/necrosis, viral load and duration of disease. A cut-off value < 23 IU/L distinguished with high diagnostic accuracy healthy controls from patients with HCV.

Gastrointestinal symptoms and psychiatric disorders are common among patients with chronic renal failure since uremia affects all systems as well as the gastrointestinal tract. Irritable bowel syndrome (IBS) is a frequent functional disorder worldwide. We aimed to evaluate the frequency of IBS and upper gastrointestinal symptoms in patients with chronic renal failure (CRF). The relationships between IBS, sex and additional psychiatric disorders in the same patient group were determined and results were compared with controls.Ninety-three hemodialysis (HD) and 35 peritoneal dialysis (PD) patients and 51 healthy volunteers were enrolled in this cross-sectional study. They completed the questionnaires that were later evaluated to determine the frequency of IBS in HD, PD and control groups; the frequency of depression and anxiety in these three groups and their relationship to sex. Symptoms of upper gastrointestinal system and their relation to sex were also investigated in all groups.In this study, we have demonstrated that prevalence of IBS in patients with chronic renal failure on hemodialysis or peritoneal dialysis is higher than the controls though the type of dialysis does not seem to influence the IBS prevalence itself. Epigastric pain was more prevalent in HD patients than PD patients.The present study suggests that though IBS is common in patients with CRF, it is generally underestimated. Type of dialysis does not seem to change the clinical picture much. Accompanying mood disorders must also be taken into consideration.

Aim To investigate the activity and toxicity of irinotecan (CPT-11) as a single agent in patients with advanced gastric cancer after failure of previous 5-fluorouracil-based combination chemotherapy. Patients and methods Sixteen patients with advanced gastric received CPT-11, 350 mg/m2 every 21 days. The median age of the patients was 54.6 years; ECOG performance status was 0-1 in 14 patients and 2 in 2 patients. Dominant metastatic sites included liver, lung, lymph nodes and peritoneum. Results No complete response was observed. Two patients (12.5%) achieved a partial response to treatment. One patient (6.25%) had a minor response. Ten patients (62.5%) had progressive disease on therapy, and 3 patients (18.75%) had stable disease. The median survival of all 16 patients was 5 months. Grade 3 neutropenia was observed in 3 patients (18.75%), grade 4 thrombocytopenia in 1 patient (6.25%), and grade 3 anemia in 1 patient (6.25%). Three patients (18.75%) suffered from grade 3 diarrhea. Conclusions CPT-11 is moderately active and a well-tolerated regimen for selected advanced gastric cancer patients who experience disease progression after receiving first-line treatment.

To investigate whether serum levels of two soluble forms of extracellular cytokeratin 18 (M30-antigen and M65-antigen) may differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis in patients with nonalcoholic fatty liver disease (NAFLD).A total of 83 patients with suspected NAFLD and 49 healthy volunteers were investigated. Patients with suspected NAFLD were classified according to their liver histology into four groups: definitive NASH (n=45), borderline NASH (n=24), simple fatty liver (n=9), and normal tissue (n=5). Serum levels of caspase-3 generated cytokeratin-18 fragments (M30-antigen) and total cytokeratin-18 (M65-antigen) were determined by ELISA.Levels of M30-antigen and M65-antigen were significantly higher in patients with definitive NASH compared to the other groups. An abnormal value (121.60 IU/L) of M30-antigen yielded a 60.0% sensitivity and a 97.4% specificity for the diagnosis of NASH. Sensitivity and specificity of an abnormal M65-antigen level (243.82 IU/L) for the diagnosis of NASH were 68.9% and 81.6%, respectively. Among patients with NAFLD, M30-antigen and M65-antigen levels distinguished between advanced fibrosis and early-stage fibrosis with a sensitivity of 64.7% and 70.6%, and a specificity of 77.3% and 71.2%, respectively.Serum levels of M30-antigen and M65-antigen may be of clinical usefulness to identify patients with NASH. Further studies are mandatory to better assess the role of these apoptonecrotic biomarkers in NAFLD pathophysiology.

AIM: To investigate the diagnostic effi cacy of leukocyte esterase and nitrite reagent strips for bedside diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: A total of 63 consecutive patients with cirrhotic ascites (38 male, 25 female) tested between April 2005 and July 2006 were included in the study. Bedside reagent strip testing was performed on ascitic fl uid and the results compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of ≥ 250/mm 3 . RESULTS: Fifteen samples showed SBP. The sensitivity, specificity, positive and negative predictive values of the leukocyte esterase reagent strips were; 93%, 100%, 100%, and 98%, respectively. The sensitivity, specifi city, positive and negative predictive value of the nitrite reagent strips were 13%, 93%, 40%, and 77%, respectively. The combination of leukocyte esterase and nitrite reagents strips did not yield statistically signifi cant effects on diagnostic accuracy. CONCLUSION: Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for SBP.

AIM: To investigate the diagnostic efficacy of leukocyte esterase and nitrite reagent strips for bedside diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: A total of 63 consecutive patients with cirrhotic ascites (38 male, 25 female) tested between April 2005 and July 2006 were included in the study. Bedside reagent strip testing was performed on ascitic fluid and the results compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of >= 250/mm(3). RESULTS: Fifteen samples showed SBP The sensitivity, specificity, positive and negative predictive values of the leukocyte esterase reagent strips were; 93%, 100%, 100%, and 98%, respectively. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strips were 13%, 93%, 40%, and 77%, respectively. The combination of leukocyte esterase and nitrite reagents strips did not yield statistically significant effects on diagnostic accuracy. CONCLUSION: Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for SBP.

OBJECTIVE: Esophageal variceal bleeding EVB due to portal hypertension in cirrhotic patients is very important because of mortality. There were contradicted results in secondary prophylaxis for variceal bleeding. In this study our primary aim is to investigate that methods to prevent variceal rebleeding are really efficacious and to establish different treatment methods clinical success. Our secondary aim is to determine of effective factors on survival period.METHODS: One hundred eighty patients with established cirrhosis disease and had variceal bleeding enrolled in this study. Patients divided into two groups as they had prophylaxis or not. Patients in the prophylaxy group were divided into seven subgroups. Survival periods, mortality proportions, and bleeding recurrency after prophylaxis are evaluated as treatment success. The factors which influenced patients treatment success are investigated. These groups evaluated clinically and compared with each other statistically.RESULTS: We started prophylaxis to one hundred thirty three of the patients enrolled and we determined survival periods of these patients decreased by their variceal grades are increased in endoscopies. Child grades of patients are related to survival periods, while the patients grade was increasing, survival period was decreasing. In the prophylaxy group, mortality proportions were significantly increased. In regard to survival period, best success in treatment groups has acquired with beta-blocker plus band ligation treatment. CONCLUSION: We concluded that, with our study results, secondary prophylaxis has advantage and is essential in patients who had EVB. The positive results achieved with beta-blocker treatment can be accepted as this groups activity and success in prophylaxis. Moreover the high clinical success with beta-blocker plus band ligation is suggesting medical treatments combination with invasive endoscopy methods are more useful for patients., AMAÇ: Siroz hastalarında portal hipertansiyona bağlı olarak gelişen özefagus varis kanamaları ÖVK , çok önemli bir mortalite nedenidir. Buna rağmen, varis kanamasının sekonder profilaksisine yönelik, birbirleri ile çelişen sonuçlar mevcuttur. Bu çalışmada varis kanamalarının tekrarının önlenmesi için kullanılan yöntemlerin klinik etkinliği ve sağkalım süreleri üzerine olan etkileri araştırılmıştır. YÖNTEMLER: Çalışmamızda siroz teşhisi konulmuş ve özefagus varis kanaması geçiren 180 hasta incelendi. Bu hastalar profilaksi almış olanlar ve profilaksi almamışlar olarak iki gruba ayrıldı. Profilaksi başlanmış olan hastalar da kullandıkları tedavi modalitesine göre 7 alt gruba ayrıldı. Bu hastalarda sağkalım süreleri, mortalite oranları ve profilaksiden sonra kanama rekürrensi değerlendirildi. BULGULAR: Çalışmaya alınan hastaların 133 tanesine profilaksi başlanmış olup, bu hastaların gastroskopilerindeki varislerin derecesinin artması ile sağkalım sürelerinin kısaldığı belirlendi. Hastaların Child evreleri de sağkalım süreleri ile doğrudan ilişkiliydi ve tedavinin başlangıcında Child derecesi yüksek olarak tespit edilen hastaların yaşam süreleri daha kısaydı. Profilaksi başlanan hastalarda mortalite oranları anlamlı derecede daha düşük, sağkalım süreleri ise belirgin olarak daha uzundu. Yaşam süresi dikkate alındığında; tedavi gruplarında en iyi başarı, beta-bloker + bant ligasyonu tedavisi ile elde edildi. SONUÇ: Bizim çalışmamızın sonuçları, ÖVK geçiren hastalarda, sekonder profilaksinin, olumlu ve yararlı etkilerini yansıtmaktadır. Beta-bloker tedavisi ile alınan olumlu sonuçlar, bu grubun profilaksideki etkinliğinin bir göstergesi olarak düşünülebilir. Ayrıca beta-blokerlerin bant ligasyonu ile birlikte kullanıldığında elde edilen yüksek klinik başarı, profilakside kullanılan medikal tedavilerin, girişimsel endoskopik yöntemlerle kombine edilmesinin, hastalar için daha yararlı olduğunu düşündürmektedir.