Muge Tuncyurek

Garlic oil and Helicobacter pylori infection

PBC. In 1989, a 45-yr-old woman was admitted to the hospital because of right upper quadrant abdominal pain, asthenia, anorexia, and weight loss in the previous 3 months. On physical examination, irregular hepatomegaly was noticed. There were no palpable adenopathy or splenomegaly. Laboratory data showed elevation of alkaline phosphatase and were otherwise within normal limits. Abdominal ultrasonography and CT scan disclosed several space-occupying lesions in right and left hepatic lobes. Fine-needle aspiration of one of these lesions was informed as metastases of poorly differentiated carcinoma. An extensive search of a primary tumor was unsuccessful. An exploratory laparotomy was performed; liver nodules and hilar adenopathy were noticed. Pathological examination of adenopathy showed a large B-cell lymphoma (centroblastic lymphoma). Extent of disease was evaluated with a chest CT scan and a bone marrow biopsy that were normal. The patient was treated with eight cycles of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone); a complete remission of liver lesions was observed. Six years later, she complained of arthralgia, pruritus, and Raynaud’s phenomenon. Antimitochondrial antibodies were positive (1/1280), and a percutaneous liver biopsy showed an inflammatory process of the portal triads with focal ductal injury, compatible with stage I PBC. Signs of malignant infiltration were not appreciated. In our patient, the diagnosis of PHL in assumable in the absence of liver histology, in view of the clinical and radiological presentation, the response to therapy with long lasting remission, and the evidence of lymphomatous involvement of the hilar lymph nodes. Unfortunately, we cannot elucidate whether PBC was present when the patient was first seen, for liver biopsy and antimitochondrial antibodies were not performed. We believe that, although our case does not fulfill the strict criteria proposed by Caccamo et al. (2), it should be considered as a PHL, because extension to affected lymph nodes probably reflects local dissemination.

The modified sequential treatment regimen containing levofloxacin for Helicobacter pylori eradication in Turkey.

Background:  Eradication rates of Helicobacter pylori have declined to unacceptable levels in recent years. New and effective treatment options are warranted both as a first and second line treatment.

The efficacy of ranitidine bismuth citrate, amoxicillin and doxycycline or tetracycline regimens as a first line treatment for Helicobacter pylori eradication.

BACKGROUND The eradication rates of Helicobacter pylori (H. pylori) clearly decreased with standard PPI-based triple therapies. AIM To assess the efficacy of two different triple therapies consisting of ranitidine bismuth citrate-amoxicillin-doxycycline and ranitidine bismuth citrate-amoxicillin-tetracycline combinations as a first line treatment option. METHODS One hundred and fifteen consecutive dyspeptic patients in whom H. pylori infection was diagnosed for the first time were enrolled in this study. The patients were randomized into two groups. Group 1 (n=57) was assigned to receive a 14-day triple therapy consisting of ranitidine bismuth citrate 400 mg (b.i.d.), amoxicillin 1 g (b.i.d) and doxycycline 100 mg (b.i.d.). Group 2 (n=58) was assigned to receive a 14-day triple therapy consisting of ranitidine bismuth citrate 400 mg (b.i.d.), amoxicillin 1 g (b.i.d.) and tetracycline 500 mg (q.i.d.). RESULTS The eradication was achieved in 45.7% (21/46) and 40.8% (20/49) of the patients in group 1 and group 2, according to per protocol analysis. The intention-to-treat eradication rates were 36.8% (21/57) and 34.5% (20/58) in group 1 and group 2, respectively. CONCLUSIONS Two-week therapy with neither ranitidine bismuth citrate-amoxicillin-doxycycline nor ranitidine bismuth citrate-amoxicillin-tetracycline is adequately effective for H. pylori eradication as a first line therapy.

Experience of the Izmir Pediatric Oncology Group on Neuroblastoma: IPOG-NBL-92 Protocol

This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkeys social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.

An Unusual Presentation of Behçet’s Disease: Intestinal Perforation

Abstract: Behçet’s disease (BD), when first described in 1937, consisted of three symptoms: recurrent oral and genital ulcerations and iridocyclitis [1]. Today, it is known that BD is a multisystemic chronic vasculitic disorder which may involve both arteries and veins of all sizes, as well as the central nervous and gastrointestinal systems. The rate of gastrointestinal involvement of BD varies in different populations, being more common in Japan (50%–60%) and less common in the Mediterranean basin, including Turkey (0%–5%) [2,3]. We present a 34-year-old Turkish woman with BD who had ileal and colonic ulcerations complicated by perforation and gastrointestinal bleeding. Special emphasis was placed on the differential diagnosis between Crohn’s disease (CD) and BD with gastrointestinal involvement.

Is it possible to diagnose infectious oesophagitis without seeing the causative organism? A histopathological study

BACKGROUND/AIMS We investigated the utility of using histological changes to diagnose infectious oesophagitis when causative organisms cannot be seen. MATERIALS AND METHODS Sixty-seven endoscopic biopsy specimens (51 Candida, 9 herpes simplex virus, 4 tuberculosis, and 3 cytomegalovirus oesophagitis) collected from 2000-2010 that matched the investigative criteria were included in the study. Cases were re-evaluated for histological changes observed in oesophagitis, and the findings were statistically compared using nonparametric tests. RESULTS Thirty-nine cases occurred in male patients, and 28 occurred in female patients; the mean age of the patients was 51±20.1 years (range, 5-94 years). All cases showed lymphocytic and neutrophilic infiltration; while 27 (40.3%) showed eosinophilic infiltration. The density of lymphocytes and eosinophils were 8.43±6 and 1.07±1.62 per high power field, respectively, and these rates were higher in tuberculosis oesophagitis cases. Lamina propria infiltration was present in herpes simplex virus and Candida oesophagitis. Dense neutrophilic infiltration (>50/high power field) was noted in herpes simplex virus oesophagitis. Candida colonization was observed in 82% of cases with eosinophilic infiltration, and 80% of cases with erosion. Ulceration was present in all tuberculosis oesophagitis cases (p<0.001). Basal cell hyperplasia, papillary elongation, and dilated intercellular spaces were seen in all cases except for 2 Candida oesophagitis cases. Lamina propria fibrosis was especially noted in cytomegalovirus oesophagitis cases. CONCLUSION It is not possible to distinguish infectious oesophagitis from other subtypes, especially reflux oesophagitis, if the causative organism is not detected. Clinicopathological correlation and control with repeat targeted biopsies are essential for diagnosis.

Can CD10 be used as a diagnostic marker in thyroid pathology

CD10–common acute lymphoblastic leukemia antigen is a membrane-bound zinc metalloproteinase that is expressed by different hematopoietic cell types at unique stages of lymphoid and myeloid differentiation. It was reported to be expressed in various nonlymphoid cells and tissue, as well as in various types of neoplasms. Recently, it has been found to be useful in the differential diagnosis of benign and malignant follicular-patterned lesions of the thyroid. In the present study, we evaluated the staining pattern of CD10 in various thyroid lesions, including 14 benign and 61 malignant cases, as well as in adjacent thyroid tissue. CD10 was negative in normal thyroid tissue, adenomatous nodules, minimally invasive follicular carcinoma, and well-differentiated carcinoma. It was expressed in nine of 14 (64.2%) conventional papillary carcinomas, four of 24 (16.6%) follicular variant of papillary carcinomas, three of six (50%) papillary microcarcinomas, one of nine (11.1%) widely invasive follicular carcinomas, and three of ten (30%) follicular adenomas. In contrast to results of previous studies, CD10 is not useful in the classification of thyroid follicular lesions as benign or malignant, but it shows strong positivity in conventional papillary carcinoma.

Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: dual concentric echo sign.

AIMS To review the detailed gray-scale and Doppler ultrasonography features of histologically proven parathyroid adenomas (PAs) evaluated with high-end ultrasonography devices and to present a novel ultrasonography finding called the dual concentric echo sign in PA with histopathologic correlation which was encountered during detailed analysis. MATERIAL AND METHODS Fifty-six PAs with histopathological result were enrolled. The longest dimension, shape, distance to skin surface, internal echo and Doppler US features obtained with high-end US devices were evaluated. RESULTS PAs had variable range of shape including oval, irregular, fusiform, lobulated, crescent-shaped, and nodular configuration. In nine patients the lesions were shown to have cystic components and calcifications were seen in four cases. Dual concentric echo sign was detected in 18% PAs. Histological reevaluation of this subgroup demonstrated significantly increased edema (p<0.01), and ectatic vessels (p=0.02) in the central part of the lesion compared to the rest of the PAs. CONCLUSIONS The results of the study led to the conclusion that PAs have variable gray-scale and Doppler findings. Typical sonographic features like ovoid shape, homogeneously hypoechoic pattern may not be present in all PAs. Dual concentric echo sign which is a novel sonographic pattern may be suggestive of a PA.

Co-existence of Gastrointestinal Stromal Tumors with Malign Epithelial Tumors: a Report of Two Cases

Abstract Aim: To emphasize the importance of a detailed observation for incidental simultaneous tumoral masses during surgery for gastrointestinal stromal tumors (GISTs) at any location in the gastrointestinal system. Case presentations: Case 1: a 39 years old female patient with an esophageal squamous cell carcinoma and a synchronous small intestinal GIST discovered incidentally during esophagectomy. Case 2: a 73 years old female patient with a gastric GIST and a synchronous colorectal cancer detected incidentally during gastrectomy. In both cases, immunohistochemical examinations of the resected specimens confirmed the coexistences of GISTs and epithelial malignancies. Conclusion: The coexistences of GISTs with epithelial tumors have been increasing in recent years. In any case of a GIST or gastrointestinal adenocarcinoma, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin.

Üst gastrointestinal sistem stromal tümörlerinin endosonografik ve histopatolojik özelliklerinin karşılaştırılması: Tek merkez deneyimi

Background and Aims: Gastrointestinal stromal tumors are mesenchymal tumors mostly prevalent at middle ages. Since endoscopy is insufficient for evaluation of gastrointestinal stromal tumors, endoscopic ultrasound is preferred and mostly used imaging technique. Gastrointestinal stromal tumor lesions with high mitotic activity and large tumor size are usually considered to have a malign potential. We aimed to investigate the correlation between the endoscopic ultrasound findings and histopathologic characteristics of gastrointestinal stromal tumors. Materials and methods: Twenty five patients who underwent endoscopic ultrasound fort he suspicion of gastrointestinal stromal tumor and have the definitive diagnosis of gastrointestinal stromal tumor histopathologically were included to the study (13M, 12F, mean age 52.1±16.3). Results: All gastrointestinal stromal tumors were located in the stomach; five of them in the fundus, 17 in the corpus and 3 in the antrum. There were ulcerations on 10 (%40) gastrointestinal stromal tumor lesions. Mean diameter of the gastrointestinal stromal tumors measured during endoscopic ultrasound evaluation (51.59±20.37mm) was highly correlated with the real tumor size (54.30±24.86 mm, r: 0.817, p