Gökhan Güngör

Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis.

Objectives Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. Materials and methods This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child–Turcotte–Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. Results There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P<0.001). Kaplan–Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P<0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2–1.3; P<0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P=0.0029; 0.841, P<0.0001 and 0.783, P<0.0001, respectively). Conclusion NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well.

Neutrophil gelatinase-associated lipocalin in prediction of mortality in patients with hepatorenal syndrome: a prospective observational study

Hepatorenal syndrome (HRS) is a severe complication of cirrhosis which is characterized by renal dysfunction and associated with poor survival. Neutrophil gelatinase‐associated lipocalin (NGAL) is a troponin‐like biomarker for human acute kidney injury.

Efficacy of ankaferd blood stopper application on non-variceal upper gastrointestinal bleeding

AIM To prospectively assess the hemostatic efficacy of the endoscopic topical use of ankaferd blood stopper (ABS) in active non-variceal upper gastrointestinal system (GIS) bleeding. METHODS Endoscopy was performed on 220 patients under suspiciency of GIS bleeding. Patients with active non-variceal upper gastrointestinal bleeding (NVUGIB) with a spurting or oozing type were included. Firstly, 8-10 cc of isotonic saline was sprayed to bleeding lesions. Then, 8 cc of ABS was applied on lesions in which bleeding continued after isotonic saline application. The other endoscopic therapeutic methods were applied on the lesions in which the bleeding did not stop after ABS. RESULTS Twenty-seven patients had an active NVUGIB with a spurting or oozing type and 193 patients were excluded from the study since they did not have non-variceal active bleeding. 8 cc of ABS was sprayed on to the lesions of 26 patients whose bleeding continued after isotonic saline and in 19 of them, bleeding stopped after ABS. Other endoscopic treatment methods were applied to the remaining patients and the bleeding was stopped with these interventions in 6 of 7 patients. CONCLUSION ABS is an effective method on NVUGIB, particularly on young patients with no coagulopathy. ABS may be considered as part of a combination treatment with other endoscopic methods.

The long-term efficacy of combining nucleos(t)ide analog and low-dose hepatitis B immunoglobulin on post-transplant hepatitis B virus recurrence

The aim of this study was to determine the long‐term efficacy of nucleos(t)ide analog (NA) and low‐dose hepatitis B immunoglobulin (HBIG) combination treatment for preventing post‐transplant hepatitis B virus (HBV) recurrence.

Liver abscess after implantation of dental prosthesis

Pyogenic liver abscesses are rare but a life-threatening important condition. Dental procedures constitute only rare cases of pyogenic liver abscesses, with only a few cases in the literature. We report a patient with liver abscess following a dental procedure. A 74 years old diabetic male patient was admitted to our hospital with complaints of fatigue, 40 °C fever, rigors and right upper quadrant pain, 3-4 d after a dental procedure. Physical examination revealed fever and tenderness in the right upper quadrant. Laboratory examination revealed leucocytosis, elevated erythrocyte sedimentation rate and C-reactive protein and moderately elevated transaminases. An abscess was detected in radiological examination in the medial part of the left lobe of liver, neighboring the gall bladder. He was successfully treated with percutaneous abscess drainage and antibiotherapy.

External Hemorrhage from a Portacaval Anastomosis in a Patient with Liver Cirrhosis

Variceal bleeding is the major complication of portal hypertension in patients with liver cirrhosis. Hemorrhage mainly occurs in gastrointestinal lumen. Extraluminal hemorrhages are quite rare, such as intraperitoneal hemorrhages. We aimed to present a variceal bleeding case from the anastomosis on the anterior abdominal wall, as an extraordinary bleeding location, in a patient with portal hypertension in whom there were no esophageal and gastric varices.

Liver Transplantation in a Patient with Acquired Dysfibrinogenemia Who Presented with Subdural Hematoma: A Case Report

Fibrinogen is one of the most abundant proteins in the blood; normal levels range from 200 to 400 mg/dL. Fibrinogen is synthesized in the liver and is essential for the clotting of blood. It also binds to platelets, supports aggregation, and plays an important role in wound healing. Fibrinogen deficiencies can be caused by decreased levels (hypoor afibrinogenemia) or defective function (dysfibrinogenemia). Dysfibrinogenemia may either be autosomal dominantly inherited or acquired and it can manifest as bleeding or thrombotic events, or in some cases both simultaneously. Situations causing acquired dysfibrinogenemia include chronic liver disease, malignancies, and autoimmune diseases. Herein, we report a liver transplant recipient with dysfibrinogenemia who presented with subdural hematoma due to liver cirrhosis.

Is there any potential or additive effect of anemia on hepatorenal syndrome

BACKGROUND/AIMS Hepatorenal syndrome (HRS) is a severe complication of advanced cirrhosis and is characterized by renal dysfunction and poor survival rates. Although anemia is a non-rare condition in advanced liver cirrhosis, there is no publication regarding the potential or additive effects of anemia on HRS and renal dysfunction in patients with cirrhosis. We investigated whether severe anemia is a precipitant factor for HRS. MATERIALS AND METHODS In this prospective study, consecutive patients with cirrhosis with and without renal dysfunction were enrolled. A total of 29 patients with cirrhosis with HRS meeting the HRS diagnostic criteria (9 patients with type 1 HRS and 20 with type 2 HRS) and 37 patients with cirrhosis without HRS were included. The demographic features, laboratory data (particularly anemic parameters), and clinical scores of patients with and without HRS were evaluated. RESULTS Grades of ascites, Child-Turcotte-Pugh (CTP) scores, and Model of End Stage Liver Disease (MELD) scores were significantly higher in contrast to hemoglobin levels; hematocrit concentrations were significantly lower in patients with type 1 and 2 HRS than in those with non-HRS stable cirrhosis. There was a negative correlation between the hemoglobin-hematocrit and serum creatinine levels. In the logistic regression analysis, the hemoglobin levels and CTP and MELD scores were statistically significant for an onset of HRS. CONCLUSION Anemia may contribute to HRS and deteriorated renal function in patients with HRS because anemic hypoxia can lead to microcirculatory renal ischemia in the kidneys and anemia can also activate sympathetic activity and hyperdynamic circulation in the pathogenesis of HRS.

Ülseratif Kolitli Bir Hastada Perikardiyal Effüzyon: Nadir Bir Olgu Sunumu

Inflamatuar barsak hastaliklarinda barsak disi belirtiler iyi tanimlanmasina ragmen kardiyak tutulum nadiren bildirilmistir. 63 yasinda erkek hasta nefes darligi ve kuru oksuruk sikayeti ile kardiyoloji poliklinigine basvurdu. Ekokardiyografide minimal perikardiyal effuzyon vardi. Gunde iki kez 600 mg Ibuprofen recete edildi. Hasta carpinti, gogus agrisi ve nefes darliginda artma olmasi uzerine dort gun sonra hastaneye basvurdu. Kardiyoloji servisine yatirildi. Tibbi hikayesinde ulseratif kolit tanisi oldugu ve alti aydir tedavi almadigi belirlendi. Tekrar yapilan ekokardiyografide effuzyonun arttigi ve sag atriyuma basi oldugu tespit edildi. Oral prednizolon ve mesalamin ile tedavi edildi. Alti gun icinde gogus belirtilerine ilaveten barsak belirtileri duzeldi ve hastaneye basvurduktan alti gun sonra iyi durumda taburcu edildi. Bu surede perikardiyal effuzyon tamamen gerilemisti. Nedeni tespit edilemeyen perikardiyal effuzyon vakalarinda ayirici tanida ulseratif kolit mutlaka dusunulmelidir. Anahtar kelimeler: Perikardiyal Effuzyon; Ulseratif Kolit; Kortikosteroid Tedavisi.Extraintestinal manifestations are well described in inflammatory bowel disease. A 63 year-old male was admitted to our clinic with the complaint of dyspnea and dry cough. Echocardiography revealed minimal pericardial effusion. He was prescribed ibuprofen 600 mg twice on a daily basis. Four days later, he was admitted to the hospital due to palpitations, chest pain and increased dyspnea. From the medical history results, it was clear that the patient had ulcerative colitis and did not have medical treatment for the last sixth months. He was treated with oral prednisolone and mesalamine. Within six days, his bowel symptoms as well as his cardiac symptoms improved for the better, and the patient was discharged in good condition on day six after his admission to hospital. Pericardial effusion was completely resolved. Ulcerative colitis, which may not be detected as an underlying cause, should be considered in pericardial effusion cases as differential diagnosis.