Göksel Bengi

Metastasis of giant cell tumor to the breast : Case report and review of the literature

Breast cancer is the most common type of malignancy in women. Of all breast cancers, 0.5–3% involve metastasis of a non-breast malignancy to the breast. Metastasis of soft tissue tumors to the breast is rarely seen. In particular, metastasis of a giant cell tumor to the breast has never been reported in the literature. We present here a case of breast metastasis in a 44-year-old woman with a diagnosis of malignant giant cell tumor originating from the distal radius and metastatic to the lung, who had been treated with radiotherapy, surgery and chemotherapy.

A comparison of the effects of infliximab, adalimumab, and pentoxifylline on rats with non-alcoholic steatohepatitis.

BACKGROUND/AIMS Non-alcoholic steatohepatitis (NASH) lacks effective medical treatment. Since tumor necrosis factor alpha (TNF-α) plays an important role in NASH pathogenesis, we aimed to investigate drugs affecting TNF-α as possible treatment options during the development of NASH. MATERIALS AND METHODS A total of 35 rats were divided into five groups and evaluated over a 6 week period. One group received a normal diet alone or in combination with the administration of infliximab, adalimumab or pentoxifylline. RESULTS NASH was successfully established in the MCD diet group. Levels of TNF-α were effectively suppressed in the three groups that received anti-TNF agents. No statistically significant differences were observed between the three agents in terms of the histological NASH score. CONCLUSION Our study showed that the anti-TNF agents infliximab, adalimumab, and pentoxifylline effectively suppress TNF-α. Although these drugs did not prevent the development of NASH, they were able to slightly reverse the NASH histopathology score and positively affect liver function tests.

Frequency, types, and treatment of anemia in Turkish patients with inflammatory bowel disease

AIM To specify the type and prevalence of anemia along with a treatment approach for inflammatory bowel disease (IBD). METHODS We conducted a retrospective study on 465 patients who were diagnosed with IBD and followed up at our hospital from June 2015 to June 2016 [male: 254, female: 211; average age: 47 ± 14.4; Crohn’s disease (CD): 257, Ulcerative Colitis (UC): 208]. Epidemiological and clinical data, such as sex, age, age of diagnosis, type of IBD, disease extension, disease behavior and duration, treatments for IBD and anemia, and surgical history were obtained for each patient. Per World Health Organization guidelines, anemia was diagnosed for males if hemoglobin values were less than 13 g/dL and for females if hemoglobin values were less than 12 g/dL. RESULTS We determined that 51.6% of the patients had anemia, which was more frequent in women then men (64% vs 41.3%, P < 0.001). Anemia frequency was higher in CD cases (57.6%) than in UC cases (44.2%) (P = 0.004). CD involvements were as follows: 48.2% in ileal involvement, 19% in colonic involvement, and 32.8% in ileocolonic involvement. Furthermore, 27.5% of UC patients had proctitis (E1) involvement, 41% of them had involvement in left colitis (E2), and 31.5% had pancolitis involvement. There was no significant relationship between anemia frequency and duration of disease (P = 0.55). Iron deficiency anemia (IDA) was the most common type of anemia in this cohort. Moreover, because anemia parameters have not been evaluated during follow-up of 15.3% of patients, the etiology of anemia has not been clarified. Fifty percent of patients with anemia received treatment. Twenty-three percent of IDA patients had oral iron intake and forty-one percent of IDA patients had parenteral iron treatment. Fifty-three percent of patients who were suffering from megaloblastic anemia received B12/folic acid treatment. CONCLUSION We found out that almost half of all IBD patients (51.6%) had anemia, the most frequent of which was IDA. Almost half of these patients received treatment. We should increase the treatment rate in our IBD patients that have anemia.

Helicobacter pylori Infection among Patients with Dyspepsia and Intrafamilial Transmission

ABSTRACT Introduction Recurrence is an important problem after Helicobacter pylori infection, and intrafamilial transmission has an important role in recurrence. In this study, we aimed to investigate the significance of intrafamilial transmission for recurrence development after treatment as well as its usefulness in prevention. Materials and methods Of the 109 patients who had dyspepsia and underwent endoscopy, 74 patients had H. pylori infection and were enrolled in this study. Infected family members were also detected. Patients were randomly divided into groups I and II, with each group containing 37 individuals. In group I, patients and their infected family members were treated together at the same time. In group II, only the patients were treated. Treatment success was evaluated at the 1st month and evaluation for recurrence was carried out at the 6th month. Results Helicobacter pylori infection was detected in 67.8% of the patients with dyspepsia. Two patients in each group did not show up at the 1st month control. Eradication was achieved in 63 of the 70 patients (90.0%) who completed their treatment. After 6 months, patients with successful treatment had no recurrence in any of the 32 patients in group I. There were recurrence in 3 of the 31 patients (9.7%) in group II; however, there was no statistically significant difference between the groups (p = 0.113). Conclusion Our study showed that eradication treatment in patients and family members with H. pylori infection resulted in a decrease in the number of recurrences even though it was not statistically significant. How to cite this article Yalçin M, Yalçin A, Bengi G, Nak SG. Helicobacter pylori Infection among Patients with Dyspepsia and Intrafamilial Transmission. Euroasian J Hepato-Gastroenterol 2016;6(2):93-96.

Pyogenic granuloma in differential iron deficiency diagnosis

To the Editor, Pyogenic granuloma (PG) is defined as a lobular benign capillary hemangioma that occurs in the skin, upper respiratory tract and mucosal surfaces of the oral cavity’s. Apart from oral cavity, it is rarely seen in the alimentary tract. These cases have been predominantly reported in the esophagus and intestine (1). Although the etiological factors of PG infection include mechanical irritation and hormones, the mechanisms underlying its development remain controversial. Here we report a rare case of gastric PG associated with chronic bleeding and iron- deficiency anemia. A 63 year old man, consulted our rheumatology outpatient clinic for chronic symmetric polyarthritis. In 1973, he underwent a partial gastrectomy due to peptic ulcer disease. The patient was admitted with chronic inflammatory symmetrical arthritis. High titers of rheumatoid factor and cCCP (Cyclic citrullinated polypeptide) were noted and rheumatoid arthritis was diagnosed. In addition, laboratory tests (Table 1), and peripheral blood smear findings were consistent with iron deficiency. Endoscopy was performed to make the differential diagnosis. A diminutive polyp was found on the posterior wall of the major curvature (Figure 1) for which polypectomy was performed. An endoscopic ultrasound (EUS) (Fujinon, Tokyo, Japan) was performed using linear echoendoscopy before the polypectomy. The lesion was confirmed on EUS to be confined to the mucosa. There were no large blood vessels or vascular spaces within the lesion (Figure 2). Histological examination of the resected specimen showed capillaries of various sized with lobular proliferations accompanied by chronic and acute inflammatory infiltrates (Figure 3). The histological features were consistent with PG. Anemia was resolved by iron supplementation. The patient provided informed consent for the above mentioned diagnostic processes. Blood loss in the gastrointestinal system is one of the leading causes of iron- deficiency anemia. A detailed examination of our patient revealed no melena or hematemesis. Considering that his vital signs were stable and mean corpuscular volume value was low, we believed that the anemia was not acute but rather was due to chronic bleeding. Since our patient had

Validity and reliability of the patient assessment of constipation quality of life questionnaire for the Turkish population

BACKGROUND/AIMS There are few specific evaluation forms for evaluating the quality of life among patients with chronic constipation. Our study aimed to determine the validity and reliability of the translated Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire for the Turkish population because evidence of its reliability and validity is required to justify its use in other studies and clinical practice. MATERIALS AND METHODS This study included 154 patients with constipation who were treated at the Department of Gastroenterology, Dokuz Eylül University Hospital between January and June 2012. The translated PAC-QOL questionnaire was completed by patients at the clinic and also at a 2-week follow-up to test its reliability. RESULTS Cronbachs alpha coefficient (internal consistency) was 0.91 (good) for the translated PAC-QOL questionnaire. Time validity was evaluated using the intraclass correlation coefficient (ICC) method, and the ICC value for all questions was confirmed as 0.68 at the 2-week follow-up. The validity of the tool in the study group was evaluated using factor analysis, and the results were highly significant (Kaiser-Meyer-Olkin value: 0.857; Bartletts test: p=0.001). Questions were categorized according to six factors based on the factor analysis, and these factors explained 65.1% of the total variation. For hypothesis verification of the tool, the correlation coefficient for PAC-QOL and PAC Symptoms (PAC-SYM) was r=0.577 (p<0.001), whereas the correlation coefficient for PAC-QOL and constipation severity score was r=0.457 (p<0.001). CONCLUSION The PAC-QOL questionnaire was reliable, although not valid because of the limited sample group.