Musa Aydinli

Celiac Disease in the Turkish Population

Celiac disease (CD) is characterized by malabsorption of nutrients in the small intestine. The availability of highly specific and sensitive serologic tests has facilitated its diagnosis, increasing the disease prevalence. The aim of this study was to determine the clinical, laboratory, and histopathological features of CD in Turkish adults. Between 1968 and 2002, CD patients presenting to the Gastroenterology Unit were evaluated retrospectively. From 2002, newly diagnosed patients were prospectively followed up. Sixty patients (39 female, 21 male) were included in the study. Mean body mass index was 22.2 ± 5.4 kg/m2. The most common symptoms were diarrhea, weight loss, and flatulence. Most common comorbidities were anemia, osteoporosis, type 1 diabetes mellitus, and steatohepatitis. Six (10.0%) patients had a family history of diabetes mellitus; one (1.7%) patient had a family history of CD. Plasma glucose and serum γ-glutamyltransferase levels were significantly higher in females than males. Most common histopathological findings were increased lymphocytes in the lamina propria (76.2%) and villus epithelium (59.5%). Over the years, the cumulative frequency of CD increased more in females than males. This is the first study in the literature showing the characteristics of CD in Turkish adults. In our previous recent study, the prevalence of tissue transglutaminase antibody positivity in Turkish healthy blood donors was 1.3%, indicating a high prevalence of CD in our population. In this study, the cumulative frequency of CD increased more in females than males. With the better understanding and increased suspicion of the disease, more patients are being diagnosed in our population.

Drug- and herb-induced liver injury: a case series from a single center.

BACKGROUND/AIMS Drug-induced liver injury (DILI) is common worldwide and has a potentially fatal outcome. It accounts for more than half of the cases of acute liver failure in the United States. Herb-induced liver injury (HILI) is a less documented condition but a growing problem. We present here the clinical characteristics and outcome of patients with drug- and herb-induced liver injury from our center. MATERIALS AND METHODS In this 4-year retrospective study, 82 patients in whom there was a causal or highly probable relationship between herbal medicine or drug use and liver disease are presented. RESULTS The mean age of patients was 43.1±14.8 years; sexual distribution was 53 females and 29 males. The major cause of hepatotoxicity was drugs (87.8%), with herbal medicine accounting for 12.2%. The leading causative agents were nonsteroidal anti-inflammatory drugs (NSAIDs) (23.1%), followed by antibiotics (19.5%). The pattern of hepatotoxicity was hepatocellular in 35 patients (42.6%), mixed in 28 (34.1%), and cholestatic in 19 patients (23.1%). Teucrium polium (known popularly as felty germander), which is a traditionally used herbal medicine of the Labiatae family in our region, was the most common cause of herb-induced liver injury and responsible in 7 of 10 herbal hepatotoxic cases. Acute liver failure developed in 3 patients (two patients related with flurbiprofen and diclofenac and one patient due to an isoniazid-rifampicin combination). CONCLUSION Antibiotics and NSAIDs were the most common etiologic agents for drug-induced liver injury. Surprisingly, herbs follow these groups of drugs and must be questioned more carefully.

Hepatic granuloma in Turkish adults: A report of 13 cases

BACKGROUND Hepatic granuloma (HG) is a well defined histopathological finding with an heterogenous clinical presentation. Diagnosis of a specific clinical entity is not possible every time. Descriptive studies may shed light on the various etiologies also common and distinctive findings among these patients. METHODS We reviewed the results of the liver biopsies of 592 patients. Characteristics of the patients with HG were extracted from the hospital charts. Laboratory studies included biochemical tests, hepatitis C virus (HCV) antibody, Brucella agglutination tests, tuberculin skin test. According to the diagnostic clues further tests (thoracic computed tomography (CT), ultrasonography, organ biopsy in addition to liver, antimitochondrial antibody, hepatitis B surface (HBs) antigen, venereal disease research laboratory (VDRL)) were performed. RESULTS HG was found in 13 of the 592 patients (2.2%). Primary biliary cirrhosis (three cases) was the most frequent cause followed by sarcoidosis, miliary tuberculosis and BCGitis (Bacillus Calmette Guerin) (two cases each). Two patients with HG could not be diagnosed. Only three patients had remarkable physical examination findings. Alkaline phosphatase and gamma-glutamyl transpeptidase were the most frequently elevated enzymes. Abdominal ultrasonography provided no specific diagnostic clue in any patient. Localization of the HGs was portal in 6 patients, parenchymal in 5 patients and both portal and parenchymal in 2 patients. Three exitus were due to BCGitis, miliary tuberculosis and fungal infection. CONCLUSIONS Tuberculosis is still among the most common etiologic factors. BCGitis has a fulminant rather than an indolent course. Abdominal ultrasonography could be used to rule out obstructive jaundice rather than to reach a specific diagnosis. Involvement of portal area by HG in most of the cases might cause obstruction of the biliary canaliculi and elevation of the cholestatic enzymes. Follow up of the difficult cases may be the best approach since the presence of HG was not proved as a bad prognostic factor for any disease.

Misdiagnosis of gossypiboma as hydatid cyst

A 51-year-old woman was admitted for diabetes control. She was found to have a firm, mobile, large epigastric mass during physical examination. Laboratory findings were within normal range. She had undergone cholecystectomy at another hospital 8 years ago. On computerized tomography (CT) of abdomen showed a large intra-abdominal cystic mass measuring 102 cm× 106 cm×181 cm, originating from duodenopyloric junction, which compressed duodenum and pylorus. The appearance of the mass was consistent with type II hydatid cyst (Fig. 1). The patient was advised albendazole therapy; 2 months later, the cyst was treated by puncture, aspiration, injection of a helminthicide, and reaspiration (PAIR) technique. Analysis of cystic fluid was not consistent with hydatid cyst. A post-treatment CT scan showed a reduced size of the cyst; however it returned to its original size within 3 months after treatment. The patient underwent a diagnostic laparotomy which detected four sponges within the cyst (Fig. 2).

Rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies with hepatitis B and hepatitis C infection: Review

BACKGROUND Viruses are common and are involved in the etiology of idiopathic rheumatological diseases. Hepatitis B virus (HBV), a member of the family Hepadnaviridae and hepatitis C virus (HCV), play an important role in the undetermined etiology of arthritis. The clinical manifestations of hepatitis B and C show similarities with various diseases, such as rheumatic diseases. Anti-cyclic citrullinated peptide (anti-CCP) is a specific serological marker for rheumatoid arthritis. OBJECTIVES The aim of this study was to analyze anti-CCP and rheumatoid factor (RF) levels in patients with a hepatitis B and C infection. MATERIAL AND METHODS Forty-four patients with hepatitis B, 43 patients with hepatitis C, 25 patients with rheumatoid arthritis, and 46 healthy control serums and their RF and anti-CCP levels were compared. RF was measured by the nephelometer, which detects IgM-RF. Anti-CCP was measured using enzymelinked immunosorbent assay (ELISA) that is included in the second-generation anti-CCP antibody assays (anti-CCP2). RESULTS The anti-CCP positivity levels were 20.5%, 32.5%, 72.4% and 10.9% for HBV, HCV and RA groups and healthy control group, respectively. When the groups were compared based on their RF positivity and anti-CCP positivity while the values for HBV and HCV group and healthy control group were the same, in RA group there is a significant difference to the rest of the groups (p < 0.01). CONCLUSIONS Anti-CCP may be positive for HBV and HCV as well, but it is a sensitive and specific immunological marker for RA diagnosis, especially in high-titres.

A case of upper extremity thrombosis in patient with ulcerative colitis.

A 58-year-old man with UC was admitted with acute onset pain along with swelling of the left upper extremity and left side of the neck. Doppler ultrasound of the left upper extremity and neck revealed extensive thrombosis (Figure 1). Routine blood tests gave normal results except for a high erythrocyte sedimentation rate, C-reactive protein, hyperfibrinogenemia, anemia, and a significantly elevated level of lipoprotein(a) (90.5 mg/dL). A thrombophilia work-up including antiphospholipid antibody, lupus anticoagulant, homocysteine, factor VIII, D-dimer, fibrinogene, proteins C and S, antithrombin III, PT G20210A, factor V Leiden (FVL) and methylene tetrahydrofolate reductase (MTHFR) were performed. The work-up was negative except for a high level of homocystein (80 mg/dL). Genetic evaluation showed heterozygous for FVL and PT gene mutations and homozigosity for the mutation C677T of the MTHFR gene. The patient was admitted to the hospital and started on low molecular weight heparin. The patient’s left arm oedema improved gradually and he had no complaints after the third month of treatment.

Varis dışı üst gastrointestinal sistem kanamasında endoskopik tedavinin başarısı ve tekrar kanama oranları

Background and Aims: Upper gastrointestinal system bleeding is an important and sometimes mortal situation. For endoscopic treatment of non-variceal upper gastrointestinal bleeding, some methods, such as injection treatment, thermal coagulation, argon plasma coagulation, and endoscopic clipping, can be used. In this study, we evaluated the relation between the endoscopic treatment modality for upper gastrointestinal bleeding and the re-bleeding rates. Materials and Methods: Patients who underwent gastrointestinal endoscopy for bleeding over a one-year period were included in the study. Results: We performed upper gastrointestinal endoscopy in a total of 5451 patients, and endoscopy was performed for upper gastrointestinal bleeding in 305 of them. In 68 of 305 patients (22.2%), there was active non-variceal bleeding. Among those patients, 38 of 68 (55.8%) had duodenal ulcer, 23 (33.8%) gastric ulcer, and 7 (10.2%) erosive gastrobulbopathy. Twenty-eight of 38 duodenal ulcer patients (73.6%) and 13 of 23 gastric ulcer patients (56.5%) had only injection treatment. Ten patients in each group (duodenal/gastric ulcer; 26.3% and 43.4%, respectively) received combined endoscopic therapy (injection treatment + thermal coagulation or injection treatment + argon plasma coagulation). In the monotherapy group, re-bleeding occurred in 4 of 28 duodenal ulcer patients (14.2%) and in 1 of 13 gastric ulcer patients (7.6%). In the combined therapy group, there was no re-bleeding in duodenal ulcer patients, but re-bleeding occurred in 2 of 10 patients (20%) with gastric ulcer. Conclusions:We believe that combined endoscopic therapy for upper gastrointestinal bleeding is more effective than monotherapy, especially in duodenal ulcer.

A Case of Patent Ductus Venosus Complicated with Tumor-Like Lesions of the Liver

Patent ductus venosus (PDV) is a very rare congenital vascular anomaly of the liver. We report a 17-year-old male patient presenting with elevated liver enzymes and multiple liver masses. Physical examination was normal except for pectus excavatum deformity. Ultrasonography revealed multiple tumor-like lesions of the liver and a dilated portal vein with mild splenomegaly. Liver biopsy obtained from liver parenchyma revealed minimal hepatocellular damage. PDV was diagnosed by CT (computed tomography) portography. The radiologic findings of chronic liver disease and multiple liver masses were attributed to presence of PDV. Although it is very rare, PDV might be a diagnostic possibility in patients with mass lesions in the liver.