Adil Coskun

Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia.

Hypertriglyceridemia causes acute pancreatitis in 1.3-3.8% of patients. We report here on two cases with severe (triglyceride level >1000 mg/dL) hypertriglyceridemia-induced acute recurrent pancreatitis. Both patients had uncontrolled hypertriglyceridemia and suffered from acute pancreatitis. No cause of secondary hypertriglyceridemia was detected. While stage E pancreatitis (Ransons score: 2) was diagnosed in the first case, stage D pancreatitis with a null Ransons score was detected in the second case. Both patients were treated with classical treatment with fluid replacement, analgesic, antibiotics and discontinuation of oral intake. Therapeutic plasma exchange (TPE) with fresh frozen plasma was performed consecutively and with two procedures on the 2nd and 3rd day in the first case. After TPE, while the triglyceride levels decreased from 4408 to 302 mg/dL, the amylase levels dropped from 4234 to 171 IU/L. In the second case, TPE was performed once daily. After TPE, the levels of triglyceride and amylase decreased from 2210 mg/dL and 1618 IU/L to 154 mg/dL and 110 IU/L, respectively. Local and systemic complications due to acute pancreatitis were not observed. Clinical signs and laboratory values improved. At the two-year follow-up of both patients, acute pancreatitis had not recurred with regular fenofibrate treatment. Hypertriglyceridemia should be considered in patients with acute recurrent pancreatitis. Although there is no definitive evidence for early application of TPE in severe hypertriglyceridemia-induced acute pancreatitis yet, therapy with TPE may be of benefit, improving the clinical course.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings.

OBJECTIVE To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases. METHODS Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates. RESULTS The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage. CONCLUSIONS The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

Coexistence of Multiple Endocrine Neoplasia Type 2B and Chilaiditi Sign: A Case Report

We present a 15-year-old female patient with medullary thyroid carcinoma, marfanoid habitus, and mucosal ganglioneuromatosis. Our case had a RET protooncogene mutation ser836 polymorphism in exon 14 and ser904 polymorphism in exon 15. Our patient is thought to be atypical MEN2B due to the absence of M918T or A883F mutations. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term “Chilaiditi syndrome” is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms as abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed with chest radiograph and thoracoabdominal CT. Our case is the first in the literature indicating the coexistence of Chilaiditi sign and MEN2B.

Therapeutic plasma exchange for hypertriglyceridemia induced acut pancreatitis: the 33 cases experience from a tertiary reference center in Turkey

BACKGROUND/AIMS Hypertriglyceridemia (HTG) is the third most common cause of acute pancreatitis. In patients with severe HTG (TG level>1000 mg/dL), it may be beneficial to immediately lower the levels of triglyceride (TG) and chylomicrons. In this study, we present one of the largest case series on the use of therapeutic plasma exchange (TPE) for hypertriglyceridemia-induced acute pancreatitis (HTG-AP). MATERIALS AND METHODS Overall, 33 patients who were admitted to our clinic for HTG-AP and underwent TPE between January 2007 and July 2017 were included in the study. Clinical data and outcomes and the reduction of triglyceride levels were examined retrospectively. RESULTS The TG level decreased by 54.4%, and the total cholesterol level decreased by 52.1% after one TPE session. The TG decrease after the second TPE session was found to be 79.4%. There were 20 (60.6%) patients with mild acute pancreatitis, 10 (30.3%) patients with moderetaly severe acute pancreatitis, and 3 (9.1%) patients with severe acute pancreatitis based on the categorization according to the revised Atlanta criteria. Regarding local complications, the acute peripancreatic fluid collection was observed in 13 (39.4%) patients, acute necrotic collection was observed in 1 (3%) patient, walled-off necrosis was observed in 1 (3%) patient, and pancreatic pseudocyst was not observed in any patient. Mortality was not determined in patients with mild and moderately severe acute pancreatitis, and its rate was 33.3% in patients with severe acute pancreatitis. The overall mortality rate was 3%. No significant complications related to TPE were noted. CONCLUSION TPE is a safe and helpful therapeutic treatment method for patients with HTG-AP and may be considered particularly in patients with severe acute pancreatitis.

Dynamics of HCV epidemiology in Aydin province of Turkey and the associated factors

This paper gives an update on the local distributions of HCV genotypes in Aydin province of Turkey, provides a comparison with the previous records, and discusses the potential causal reasons shaping the evolving genotype profiles. Patient files from 2011 to 2016 were retrospectively analyzed, and newly detected cases were documented. Out of 286 patients, male and female ratios were determined to remain nearly the same (~50%). Genotype 1 was still the most common (90.2%), followed by genotype 3 (5.9%), genotype 2 (2.1%), and genotype 4 (1.4%) in frequency. There were international patients (4.50%). One patient had genotyped 2+3 together. Genotypes 4 and 2+3 were detected for the first time, and the patients with genotype 4 were interestingly all male and also domestic individuals. However, these patients traveled or lived abroad in the past due to occupational reasons, thereby likely acquired the infection while abroad. HCV surveillance system is currently inadequate and some infected patients may go undetected in the province. Remapping the regional distribution of HCV genotypes from time‐to‐time is required for identifying the local dynamics and causes leading to it. This process enhances the clinical preparation and readiness for the better management of the disease.

Cetirizine-induced hepatotoxicity: case series and review of the literature

Abstract Drug-induced liver damage is a frequently encountered clinical table caused by many drugs. Cetirizine is a widely preferred and prescribed antihistaminic agent for allergic disorders due to its non-sedative properties. In view of the literature, we present four cases of hepatotoxicity due to cetirizine use. We conclude that in patients with high levels of liver enzymes of unknown origin, cetirizine as well as other hepatotoxic drugs should be reconsidered.

Antiphospholipid Syndrome, Factor V Leiden Mutation and Chronic Viral Hepatitis B: A Case with Extremely Numerous Recurrent Miscarriage

The Antiphospholipid Syndrome (APS) is a prothrombotic disorder associated with autoantibodies, and used ‘Sapporo criteria’ or revised ‘Sydney criteria’ for classification. APS may be with primary or secondary to systemic lupus erythematosus, or infectious diseases. Viral infections, especially HCV may lead chronic antigenic stimulation, and induce autoimmunity and antiphospholipid antibodies due to molecular mimicking. Such as APL, factor V Leiden mutation also lead to thrombotic events. These two disorders are also reported rarely in literature. Our aim is to present 37-year-old female patient who had medical history of extremely numerous recurrent miscarriage with combination of antiphospholipid syndrome, factor V Leiden mutation and chronic viral hepatitis.

The role of mean platelet volume in patients with non-specific abdominal pain in an emergency department.

Introduction Platelets play an important role in inflammation. Mean platelet volume (MPV) may be a useful parameter for inflammatory conditions, in differentiating between non-specific abdominal pain (NSAP) and conditions requiring surgery, or early diagnosis of abdominal pain as a serious problem for emergency services. Aim To investigate the role of MPV on NSAP admittance to the emergency department. Material and methods The study consisted of 330 patients (186 female and 144 male, with mean age 49 ±20 years) with NSAP and 249 patients with abdominal pain (144 female and 105 male, with mean age 49 ±19 years) applied to our emergency service and enrolled to our study. Medical history, physical examination, complete blood count (CBC), and biochemical parameters were evaluated. Haematological parameters were measured by Beckman Coulter LH 780 instrument. Data were compared using Students t test, and p < 0.05 was accepted as statistically significant. Results The MPV were significantly lower in patients with NSAP than in others (p = 0.025). There was no significant difference between both sexes with regard to MPV (p > 0.05). Moreover, the other haematological parameters (haemoglobin, platelet, or WBC counts) were not statistically different between both groups (p > 0.05). Conclusions The MPV may be a useful, simple, and inexpensive parameter to diagnose or differentiate between NSAP and other conditions.

Gastric involvement of sarcoidosis in a patient with multiple lung nodules

Sarcoidosis is a granulomatous disorder mostly could involve intrathoracic structures. The gastric involvement is rare and the symptoms may be non-specific. We herein report a case of a 56-year-old female patient who was admitted due to chest tightness and discomfort. Computed tomography (CT) of the thorax revealed bilaterally nodular lesions in the lower lobes of the lung and pleural effusion on the left side. Positron emission tomography/CT showed lung nodules and gastric involvement with mesenteric lymphadenomegalies with pathological uptake of 18F-fluoro-2-deoxy-d-glucose. Pathological examination of the lung biopsy taken by thoracotomy demonstrated non-caseating granulomas. The gastric biopsies taken by endoscopy also showed non-caseating granulomas consistent with a diagnosis of sarcoidosis.

Aydın bölgesindeki üst gastrointestinal sistem malignitelerinin özellikleri

Giris ve Amac: Ust gastrointestinal sistem maligniteleri tum dunyada onemli mortalite ve morbidite nedenlerindendir. Tanida ozofagogastroduodenoskopi altin standart islemdir. Calismadaki amacimiz endoskopi unitemizde ozofagogastroduodenoskopi islemi ile tespit ettigimiz ve biyopsi ile de tanisi kesinlesen ust gastrointestinal sistem malignitelerinin yas, cinsiyet, lokalizasyon ile histopatolojik tipleri ve islem oncesi hasta semptomlari gibi bazi ozelliklerini belirlemekti. Gerec ve Yontem: Endoskopi unitemizde ozofagogastroduodenoskopi yapilan 7.688 hastadan malignite saptanan 209 (%2,71) vaka calismaya alindi. Bulgular: Ozofagogastroduodenoskopi isleminde malignite saptanan hastalarin 145’i erkek (%69,4), 64’u kadin (%30,6) olup yas ortalamasi 62,18±12,07 yildi. Malignitelerin %21,1’i ozofagusta, %75,1’i midede ve %3,8’i duodenumda saptandi. Yapilan histopatolojik incelemede, ozofagus kanserlerinin %84,1’i squamoz hucreli karsinom, %15,9’u adenokarsinom; mide kanserlerinin %87,9’u adenokarsinom, %3,8’i malign epitelyal tumor, %5,8’i lenfoma, %2,5’i noroendokrin tumor; duodenum kanserlerinin %87,5’i adenokarsinom, %12,5’i malign epitelyal tumor olarak tespit edildi. Sonuc: Ust gastrointestinal sistem maligniteleri en sik midede, 2. siklikta ozofagusta saptanmaktadir. Nadirde olsa duodenumda tumor gorulebilmektedir.