Ibrahim Koral Onal

Ankaferd Blood Stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract

latory failure, morbidity, and mortality are still important life-threatening prob- lems in this clinical setting. ABS may be useful as an adjunctive agent to mechan- ical intervention in cases of serious arte- rial bleeding. Neither any local adverse effect nor systemic toxicity was observed following the topical application of ABS.

Hemostatic Efficacy of Ankaferd Blood Stopper® in a Swine Bleeding Model

Objective: The purpose of this study was to show the hemostatic effect of spray, solution and tampon forms of Ankaferd Blood Stopper® (ABS), a unique medicinal plant extract historically used as a hemostatic agent in Turkish folklore medicine, in a porcine bleeding model. Materials and Methods: Two 1-year-old pigs were used as bleeding models for superficial and deep skin lacerations, grade II liver and spleen injuries, grade II saphenous vein injury and grade IV saphenous artery injury. Spray, solution or tampon forms of ABS were applied after continuing bleeding was confirmed. The primary outcome was time to hemostasis. Volume of blood loss was not measured. The pigs were euthanized at the end of the experiment. Results: Spray or direct application of ABS solution resulted in instant control of bleeding in superficial and deep skin lacerations as well as puncture wounds of the liver. A 40-second application of ABS tampon was sufficient to stop bleeding of skin lacerations, while 1.5- and 3.5-min applications were used to control hemorrhage from the saphenous vein and artery, respectively. No rebleeding was observed once hemostasis was achieved. However, repeated applications of ABS solution and tampon were only temporarily effective in the hemostasis of spleen injury. Conclusions: The data showed that ABS was an effective hemostatic agent for superficial and deep skin lacerations and minor/moderate trauma injuries in a porcine bleeding model.

Endoscopic topical application of Ankaferd Blood Stopper for neoplastic gastrointestinal bleeding: A retrospective analysis

AIM The aim of this study was to retrospectively assess the haemostatic efficacy of the endoscopic topical use of Ankaferd Blood Stopper (ABS) in the setting of neoplastic GI bleeding. METHODS The records of 10 patients with neoplastic GI bleeding (7 gastric, 3 rectal) were evaluated retrospectively. Written informed consent regarding the off-label use of ABS as a means of attaining haemostasis had been obtained from all of the patients prior to the procedure. In all patients, ABS was applied topically. Rates of bleeding control and post-procedural complications were documented. RESULTS Haemostasis was achieved in all patients within seconds of endoscopic application of ABS, with no immediate complications. Seven patients underwent subsequent cancer surgery after a bleeding-free post-procedural period. CONCLUSIONS ABS as a novel haemostatic agent could have a potential benefit in controlling bleeding from GI tumours. Prospective controlled studies are needed to help establish its efficacy, and perhaps offer a comparison to conventional haemostatic interventions.

Tandem oral, rectal, and nasal administrations of Ankaferd Blood Stopper to control profuse bleeding leading to hemodynamic instability

Ankaferd Blood Stopper (ABS) (Ankaferd Health Products Ltd., Istanbul, Turkey) is a standardized unique combined medicinal plant extract, which has been approved in the management of postsurgery dental bleeding and external hemorrhage in Turkey. ABS induces a very rapid formation (<1 second) of a specific hemostatic protein network within vital erythroid aggregation in the injured vascular area. The data on the efficacy of ABS in gastrointestinal (GI) system bleeding is limited to case reports only. Here, we present a patient with a severe GI mucosal bleeding and nasal hemorrhage leading to hemodynamic instability, which was successfully controlled via the topical application of high-dose ABS.

Serum levels of MMP-9 and TIMP-1 in primary hypertension and effect of antihypertensive treatment☆

BACKGROUND Matrix metalloproteinases, a family of proteolytic enzymes are thought to be involved in extracellular matrix accumulation during development of hypertensive target organ disease. The present study was designed to compare hypertensive patients with normotensive individuals with respect to serum levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 and to search for the effect of antihypertensive treatment on the serum enzyme levels. METHODS Thirty-three patients with stage 1 primary hypertension and sixteen age- and sexmatched control subjects were enrolled into the study. Serum MMP-9 and TIMP-1 levels were assessed in the hypertensive group before and after a 3-month-antihypertensive treatment (candesartan 8 mg/day to 17 patients and lisinopril 10 mg/day to 16 patients). RESULTS Pre-treatment serum MMP-9 levels were higher in the hypertensive group (p=0.309) while serum TIMP-1 levels were lower (p=0.296). Serum MMP-9 levels were decreased (p<0.001) and TIMP-1 levels were increased (p=0.022) after the antihypertensive treatment. CONCLUSIONS In hypertensive patients, increased MMP-9 activity could result in increased degradation of elastin relative to collagen and non-elasticity, while decreased TIMP-1 activity could lead to accumulation of poorly cross-linked, immature and unstable fibril degradation products, which result in misdirected deposition of collagen. Our study is important for revealing the role of the MMP enzyme system in the pathogenesis of hypertensive target organ disease.

Ankaferd Blood Stopper for controlling gastrointestinal bleeding due to distinct benign lesions refractory to conventional antihemorrhagic measures.

OBJECTIVE To assess the hemostatic efficacy of the Ankaferd Blood Stopper (ABS, Ankaferd Health Products Ltd, Turkey) hemostatic agent for controlling gastrointestinal bleeding associated with various benign lesions refractory to conventional antihemorrhagic measures. METHODS The records of all patients who underwent upper and lower endoscopy procedures at the Turkiye Yuksek Ihtisas Teaching and Research Hospital (Ankara, Turkey) between April 2008 and June 2009 were reviewed. Patients in whom ABS was used as a primary or adjuvant hemostatic agent were included in the study. Rates of bleeding control and postprocedural complications were documented. RESULTS Hemostasis with no immediate complications was achieved in all patients within seconds of endoscopic application of ABS. CONCLUSIONS ABS may have a role as a primary treatment or as an adjuvant to conventional modalities used to control gastrointestinal bleeding. Prospective controlled studies are needed to help establish its efficacy and, perhaps, offer a comparison with conventional hemostatic interventions.

The role of mean platelet volume in the diagnosis of hepatocellular carcinoma in patients with chronic liver disease.

BACKGROUND/AIMS Hepatocellular carcinoma (HCC) has poor long-term prognosis so we need new diagnostic techniques and markers to detect HCC in the early phases. The aim of this study was to analyze the levels of serum mean platelet volume in HCC. METHODOLOGY The clinical data of 230 subjects with normal, chronic hepatitis, cirrhosis and HCC were retrospectively analyzed at our hospital between January 2009 and December 2009. The levels of MPV were determined in patients with liver disease and compared between patient groups and with healthy persons. RESULTS Serum MPV levels were significantly increased compared to the patients with chronic hepatitis, cirrhosis, and the control group (p<0.01). The cut-off value for MPV for the detection of HCC in cirrhotic patients was calculated as ≥9.2fl using ROC analysis [Sensitivity: 68.3%, specificity: 62.1%, AUC: 0.676 (0.580-0.773), p<0.001]. Additionally, serum MPV levels show higher sensitivity for diagnosis of HCC than AFP. An AFP of more than 7.4IU/mL and an MPV of ≥9.2fl, both put together, had a specificity of 95.2%, while when used separately, they have a sensitivity of 87.5%. CONCLUSIONS MPV may be a potential or adjunctive marker of HCC in patients with chronic liver disease.

Nonconvulsive Status Epilepticus Due to Ifosfamide

Objective: To report 2 cases of nonconvulsive status epilepticus (NCSE) following infusion of ifosfamide. Case Summaries: Two patients who received ifosfamide-containing chemotherapy developed NCSE. One woman received ifosfamide 1000 mg/m2 (1 h infusion on days 1–5); confusion, lethargy, and speech deterioration developed on day 3. The second patient developed similar symptoms on day 3 of treatment with 2500 mg/m2. Both patients responded to intravenous administration of diazepam 10 mg and were given levetiracetam as maintenance therapy. Discussion: The severity and presentation of central nervous system toxicity due to ifosfamide varies greatly and involves a spectrum ranging from subclinical electroencephalogram changes to coma. NCSE, an epileptic disorder in which typical convulsive activity is absent, has previously been reported in only 4 patients receiving ifosfamide. Levetiracetam may be used for maintenance antiepileptic therapy after diazepam administration. Conclusions: Among the many presentations of ifosfamide neurotoxicity, clinicians should consider NCSE as a possible explanation for changes in consciousness in a patient receiving this agent. An objective causality assessment by use of the Naranjo probability scale revealed that NCSE due to ifosfamide was probable.

Group B streptococcal facet joint arthritis: case report.

Study Design. Case report. Objective. To report a previously undescribed complication of group B streptococcal infective endocarditis, which was lumbar facet joint arthritis. Summary of Background Data. Lumbar facet joint arthritis is a rare clinical condition, and the casual pathogen is generally Staphylococcus aureus. Streptococcus agalactiae usually causes peripartum infections affecting the mother and newborn. It rarely causes infective endocarditis, and facet joint arthritis has never been reported before. Methods. A case of group B streptococcal infective endocarditis and lumbar facet joint arthritis is described. The clinical course, treatment, and complications of facet joint arthritis and infective endocarditis are discussed. Results. A nonimmunocompromised patient presenting with fever and back pain was diagnosed to have S. agalactiae bacteremia. Subsequent imaging with echocardiography revealed mitral valve infective endocarditis and magnetic resonance imaging of lumbar spine showed left L5–S1 facet joint arthritis. Emergent intravenous antibiotic treatment and mitral valve replacement resulted in complete resolution. Conclusions. Facet joint septic arthritis should be considered in the differential diagnosis of patients presenting with fever and back pain. S. agalactiae should also be considered among the causal pathogens, and, if present, emergent antibiotic treatment, follow-up for complications, and a thorough search for the source of the hematogenous spread, which can be a life-threatening infection, are essential.

Peripheral T-cell lymphoma and Job's syndrome: a rare association.

Jobs syndrome or hyper-immunoglobulin E syndrome is a primary immunodeficiency characterized by recurrent staphylococcal abscesses and markedly elevated serum immunoglobulin E concentrations. Here we report a case of a woman with hyper-immunoglobulin E syndrome with a diagnosis of peripheral T-cell lymphoma, and we review the pertinent literature.