Ilyas Tuncer

Instant control of fundal variceal bleeding with a folkloric medicinal plant extract: Ankaferd Blood Stopper.

1. Bose S, De Bakshi S, Banerjee A, et al. Three cases of massive bleeding from pancreatic pseudocysts. HPB (Oxford) 2003;5:114-7. 2. Sakorafas GH, Sarr MG, Farley DR, et al. Hemosuccus pancreaticus complicating chronic pancreatitis: an obscure cause of upper gastrointestinal bleeding. Langenbecks Arch Surg 2000;385:124-8. 3. Aziz F, Savino JA, Mazen S, et al. Pancreatic pseudoaneurysm. eMedicine 4. Massani M, Bridda A, Caratozzolo E, et al. Hemosuccus pancreaticus due to primary splenic artery aneurysm: a diagnostic and therapeutic challenge. JOP 2009;10:48-52. 5. Kapoor S, Rao P, Pal S, et al. Hemosuccus pancreaticus: an uncommon cause of gastrointestinal hemorrhage. A case report. JOP 2004;5:373-6. 6. Mathew AJ, Raju RS, Vyas FL, et al. Left gastric artery pseudoaneurysm following traumatic pancreatic transection. Trop Gastroenterol 2007; 28:133-4. 7. Falodia S, Garg PK, Bhatia V, et al. EUS diagnosis of a left gastric artery pseudoaneurysm and aneurysmogastric fistula seen with a massive GI hemorrhage. Gastrointest Endosc 2008;68:389-91 Epub 2008 Mar 4. 8. Jani ND, McGrath KM. Left gastric artery aneurysm. Gastrointest Endosc 2008;67:154-5 commentary 155. 9. Smith RE, Fontanez-Garcia D, Plavsic BM. Gastrointestinal case of the day. Pseudoaneurysm of the left gastric artery as a complication of acute pancreatitis. Radiographics 1999;19:1390-2. 10. Dahan H, Arrivé L, Monnier-Cholley L, et al. Imaging of a case of wirsungorrhagia [French]. J Radiol 1997;78:589-91.

Metabolic syndrome frequency in inflammatory bowel diseases.

Background/Aim: Metabolic syndrome (MetS) is a clinical condition characterized by central obesity, elevated triglycerides, low–high density lipoproteins, impaired fasting glucose, and hypertension. There is insufficient data on the prevalence of MetS in patients with inflammatory bowel disease (IBD). This study sought to determine the prevalence of MetS in a Turkish cohort of patients with IBD and the association between insulin resistance (IR) and the MetS parameters, in this population. Patients and Methods: A total of 177 patients over 18 years of age (62 with Crohns disease (CD) and 115 with ulcerative colitis (UC)) were enrolled in the study. The presence of at least three criteria of the International Diabetes Federation (IDF) was accepted for the diagnosis of MetS. The Homeostasis Model Assessment (HOMA) was used to determine IR. HOMA values < 1 were considered normal and values > 2.5 indicated a high probability of IR. Results: MetS frequency was higher in patients n=34 (29.5%) with UC than in patients n=11 (17.7%) with CD (P < 0.01). MetS was detected in 12 of the 117 patients (10.3%) with IBD, under 45 years of age, and in 33 of 60 patients (55%) over 45 years of age. HOMA value in n=31 patients (27%) with UC was > 2.5. Body mass index, insulin (P < 0.001), waist circumference, fasting plasma glucose, leukocyte count (P < 0.01), triglycerides, C-reactive protein, and uric acid values (P < 0.05) were significantly higher in UC patients with IR than those without IR. Conclusion: Frequent occurrence of MS with increasing age in IBD, particularly in UC, showed the importance of early diagnosis and treatment of cardiovascular disease risk factors in the long-term follow-up of these diseases.

Serum osteopontin levels as a predictor of portal inflammation in patients with nonalcoholic fatty liver disease

BACKGROUND Osteopontin is a secreted phosphorylated glycoprotein that is expressed by a variety of cell types and that mediates numerous and diverse biological functions. Osteopontin knockout mice are protected from obesity-induced hepatic steatosis. In the present study, we sought to investigate whether serum osteopontin concentrations are associated with liver histology in patients with nonalcoholic fatty liver disease. METHODS Serum levels of osteopontin were measured by enzyme-linked immunosorbent assay in 179 well-characterized patients with nonalcoholic fatty liver referred for liver histology and 123 control subjects. RESULTS Serum osteopontin levels were markedly higher in patients with nonalcoholic fatty liver disease than in controls (p<0.001). Multivariable analysis showed that osteopontin levels were strongly and independently associated with both portal inflammation (β=0.294, p<0.01) and serum aminotransferase levels (aspartate aminotransferase: β=0.295, p<0.01; alanine aminotransferase; β=0.285, p<0.01). CONCLUSION In summary, these data demonstrate that serum levels of osteopontin are elevated in nonalcoholic fatty liver disease and are a significant independent predictor of portal inflammation in this clinical entity.

Is the lymphoma risk reduced in viral hepatitis? A cirrhotic patient with triple malignancies.

Is the Lymphoma Risk Reduced in Viral Hepatitis? A Cirrhotic Patient With Triple Malignancies

Massive Upper Gastrointestinal Bleeding Caused by Diffuse Large B-Cell Lymphoma

Massive upper gastrointestinal bleeding is a life-threatening emergency which needs urgent intervention. Hematological malignancies are very rare causes of this type of bleeding and they usually originate from duodenum. In this case we present a gastric diffuse large B-cell lymphoma (DLBCL) causing massive upper gastrointestinal system bleeding. A 77-year-old male patient was admitted to emergency clinic with hematemesis and hematochezia. In physical examination patient was pale and sweaty; his vitals were unstable with a heart rate of 110 per minute and a blood pressure of 90/50 mmHg. His hemoglobin level was found 7.5 g/dL and he was transfused with one unit of packed red blood cells. After his vitals were normalized, gastroscopy was performed showing mosaic pattern in corpus and antrum mucosa and multiple ulcers in various sizes, largest being approximately 2 cm in diameter, higher than mucosa covered with exude mostly on corpus and large curvature. Biopsy results were reported as DLBCL. Gastric mucosa is involved in most of the DLBCL cases. Although not listed as a common cause of massive gastrointestinal bleeding DLBCL can cause life-threatening situations mostly because of its malignant nature.