Ali Tüzün

The diagnostic value of on‐site cytopathological evaluation and cell block preparation in fine‐needle aspiration cytology of liver masses

Objective:  The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on‐site cytopathological evaluation improves the diagnostic yield of liver fine‐needle aspiration cytology (FNAC).

Adjuvant therapeutic plasma exchange in liver failure: assessments of clinical and laboratory parameters.

Background Therapeutic plasma exchange (TPE) seems to be an effective approach for clearing toxins, immune-mediated antigens, and other particles from the circulation. The aim of this study was to analyze the positive effects of TPE on clinical and biochemical parameters of liver failure. Patients and Methods Between January 2001 and March 31, 2005 individuals (men/women, 17/14; median age, 42.7±15.8 y) with acute and chronic liver failure who underwent a total of 113 TPEs (median session 3.7) were retrospectively reviewed. TPE was performed using the Fresenius AS-TEC 204 cell separator (Fresenius AG, Germany). The indication for TPE was severe coagulopathy (prothrombin time >20 s), severe hepatic encephalopathy, hyperbilirubinemia, and candidacy for liver transplantation. All patients were examined before and immediately after the last TPE session. Results When compared with baseline, there was significant improvement in hepatic encephalopathy stage (from median score 3.0 to 1.0, P=0.001), serum prothrombin time (from median 26.0 to 20.0 s, P=0.003), aminotransferases (P<0.001), and total bilirubin levels (from median 35.0 to 23.3 mg/dL, P<0.001) after TPE. Thirteen of the thirty-one individuals (41.9%) died in the hospital. The mean follow-up period of 18 survival patients was 35.9±5.6 months and 10 of those survived (55.6%, 10/18). No serious adverse effect of TPE was observed in any of the patients during or after completion of TPE. Only 6 patients experienced minor transfusion reactions. Conclusions TPE seems to be effective in improving hepatic encephalopathy stage and liver tests in individuals with acute and chronic liver failure. The data suggest that TPE is safe and tolerable in such individuals, however, overall survival remains poor despite TPE.

Association Between Level of Hepatitis D Virus RNA at Week 24 of Pegylated Interferon Therapy and Outcome

BACKGROUND & AIMS Interferon is the only effective treatment for chronic hepatitis D virus (HDV) infection. No rules have been set for stopping treatment based on viral kinetics. We analyzed data from an international study of hepatitis D treatment to identify factors associated with outcomes of pegylated interferon treatment, with and without adefovir. METHODS We analyzed data from the Hep-Net-International Delta Hepatitis Intervention Trial on 50 patients with compensated liver disease who tested positive for anti-HDV and HDV RNA. Subjects received pegylated interferon α 2a, with adefovir or placebo, or only adefovir, for 48 weeks. Twenty-four weeks after treatment ended, 41 patients were evaluated for levels of HDV RNA and DNA, liver enzymes, and hepatitis B surface antigen (HBsAg); liver biopsy specimens were analyzed for fibrosis. Response to therapy was defined as end-of-treatment response or post-treatment week 24 virologic response. In both cases virologic response was associated with undetectable HDV RNA levels. Patients with less than a 1 log decrease in HDV RNA at the end of treatment were considered null responders. RESULTS Based on univariate and multivariate analysis, the level of HDV RNA at week 24 of treatment was associated more strongly with response to therapy than other factors analyzed. The level of HBsAg at week 24 of treatment was associated with a response to therapy only in univariate analysis. Lack of HDV RNA at week 24 of treatment, or end of treatment, identified responders with positive predicted values of 71% and 100%, respectively. At 24 weeks after treatment, a decrease in HDV RNA level of less than 1 log, combined with no decrease in HBsAg level, identified null responders with a positive predictive value of 83%. A decrease in HDV RNA level of more than 2 log at week 24 of treatment identified null responders with a negative predictive value of 95%. CONCLUSIONS Based on an analysis of data from a large clinical trial, the level of HDV RNA at week 24 of treatment with pegylated interferon, with or without adefovir for 48 weeks, can identify patients who will test negative for HDV RNA 24 weeks after the end of treatment. This information can be used to help physicians manage patients receiving therapy for chronic hepatitis D.

Long‐term prognosis of nonalcoholic fatty liver disease: Is pharmacological therapy actually necessary?

Background and Aim:  Nonalcoholic fatty liver disease (NAFLD) comprises a wide spectrum of liver injury, ranging from steatosis and steatohepatitis to cirrhosis. Reasons for the different natural course in individuals with NAFLD are still unclear. The aim of this study was to describe the natural course of disease in individuals with NAFLD who did not receive pharmacological therapy.

The predictive value of mean platelet volume, plateletcrit and red cell distribution width in the differentiation of autoimmune gastritis patients with and without type I gastric carcinoid tumors

Abstract Autoimmune gastritis is an autoimmune and inflammatory condition that may predispose to gastric carcinoid tumors or adenocarcinomas. The early diagnosis of these tumors is important in order to decrease morbidity and mortality. Platelet indices such as mean platelet volume and plateletcrit levels increase in inflammatory, infectious and malign conditions. The primary aim of this study was to explore wheter platelet indices and red cell distribution width have any predictive role in the discrimination of autoimmune gastritis patients with and without gastric carcinoid tumors. Also secondary aim of this study was to investigate whether any changes exist betwenn autoimmune gastritis and functional dyspepsia patients by means of platelet indices. Plateletcrit (0.22 ± 0.06 vs. 0.20 ± 0.03%, p < 0.001) and red cell distribution width (16.11 ± 3.04 vs. 13.41 ± 0.95%, p < 0.001) were significantly higher in autoimmune gastritis patients compared to control group. Receiver operating curve analysis suggested that optimum plateletcrit cut-off point was 0.20% (AUC: 0.646), and 13.95% as the cut off value for red cell distribution width (AUC: 0.860). Although plateletcrit (0.22 ± 0.06 vs. 0.21 ± 0.04%, p = 0.220) and mean platelet volume (8.94 ± 1.44 vs. 8.68 ± 0.89 fl, p = 0.265) were higher in autoimmune gastritis patients without carcinoid tumor compared to patients with carcinoid tumors, these parameters were not statistically significant. Changes in plateletcrit and red cell distribution width values may be used as a marker in the discrimination of autoimmune gastritis and fucntional dyspepsia patients but not useful in patients with gastric carcinoid tumor type I.

Factors related to low serum vitamin B12 levels in elderly patients with non‐atrophic gastritis in contrast to patients with normal vitamin B12 levels

Vitamin B12 deficiency is frequent in older patients, and the main reason is pernicious anemia. However, vitamin B12 deficiency can occur in patients who do not have atrophic gastritis. The aim of the present study was to investigate factors affecting serum vitamin B12 levels in older patients with non‐atrophic gastritis.

A New Percutaneous Approach for the Treatment of Hydatid Cyst of the Kidney: Long-term Follow-up

Renal hydatid disease is an uncommon benign parasitic infestation compared to liver hydatid disease. Although the treatment of hydatid cysts depends on surgery which is related with high morbidity and an overall local recurrence rates, the following case reports describing two patients with renal hydatid cysts were successfully treated with this new percutaneous method.

The Risk of Ileocolonic Perforation in Patients with Behet's Disease: Report ofThree Cases and Review of the Literature

Introduction/Purpose: Intestinal Behcet’s disease may cause serious complications. Massive hemorrhage, fistulisation and intestinal perforation are encountered complications in approximately 50% of patients suffering from intestinal Behcet’s disease. Currently, there is not enough data inquiring iatrogenic ileocolonic perforation during colonoscopy in patients with intestinal Behcet’s disease; therefore we aimed to study intestinal Behcet’s disease patients who suffered perforation during or after colonoscopy. Methods: A total of 2615 colonoscopic examinations were performed between May 2002 and December 2007. Of these 2615 patients, main indication for colonoscopy was intestinal Behcet’s disease in 135 patients. Results: In total 135 patients with Behcet’s patients were assessed with colonoscopy due to presumed ileocolonic involvement. 8 out of 135 (5.9%) patients had ileal and colonic ulcers. 3 patients (2.22%) had iatrogenic perforation, 2 of whom had profound ulcers in proximal colon and ileum. The third case had ulcers in sigmoid colon, descending and transverse colon segments. All these 3 patients had undergone surgical intervention including ileal resection and right hemicolectomy. Discussion: Colonoscopic examination is commonly used in Behcet’s disease not only for diagnostic purposes but also for surveillance of intestinal involvement in Behcet’s disease. Volcano-shaped ulcers are specially inclined to perforate. Both clinicians and endoscopists should be alert against barotrauma applied during colonoscopy may cause perforation. Also patients should be followed-up necessarily and in case of abdominal pain after colonoscopic examination, colonic perforation should always be kept in mind.f

Percutaneous treatment with the Örmeci technique for hydatid disease located in the spleen: Single center experience for twenty six years

BACKGROUND/AIMS Hydatid disease remains an important global socioeconomic health problem, particularly in the endemic areas. Although half of the patients show no symptoms, hydatid cysts should be treated because of their fatal complications. The aim of this study is to present the long-term results of percutaneous treatment of hydatid disease using the Örmeci technique. MATERIALS AND METHODS Forty-nine patients with 54 cystic lesions were diagnosed with hydatid disease. Twenty-seven of the 54 hydatid cysts located in the spleen were punctured with a 22-gauge Chiba needle through the parenchyma of the spleen under sonographic guidance as a one-step procedure. For every 1 cm of the long diameter of the cyst lesion, 3 cc of fluid from the cysts was aspirated. For each centimeter of the long diameter, 2 cc of pure alcohol (96%) and 1 cc of polidocanol (1%) were injected into the cysts. Five out of 27 patients did not participate in the follow-up. RESULTS The 22 patients who were treated using the percutaneous Örmeci technique were followed up for a mean±SD (median) of 50.32±65.30 (26.00) months (minimum 4 and maximum 298 months). All patients except one were successfully treated. No deaths or major complications were noted. Seven patients experienced minor complications. CONCLUSION Percutaneous treatment with the Örmeci technique is a safe, effective, cheap, and reliable method that does not interfere with splenic functions, and this outpatient procedure should be the method of choice for a surgery alternative.

Utility of three prognostic risk scores in predicting outcomes in elderly non-malignant patients after percutaneous gastrostomy

Background/ObjectivesPercutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. Design: Retrospective cohort study.SettingUniversity hospital in Turkey.Participants155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy.Measurements“Geriatric Nutritional Risk Index”, “Malnutrition Universal Screening Tool” (MUST) and “Portsmouth- Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity” (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined.ResultsThe mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of “Geriatric Nutritional Risk Index” was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for “Geriatric Nutritional Risk Index” (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a “Geriatric Nutritional Risk Index” score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a “Geriatric Nutritional Risk Index” score of < 82 had the worst outcome.ConclusionsA scoring system such as “Geriatric Nutritional Risk Index” should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.