Reskan Altun

Idiopathic chylous ascites treated with total parenteral nutrition and octreotide. A case report and review of the literature

Chylous ascites is the accumulation of lipid-rich lymph in the peritoneal cavity. The usual cause in adults is lymphatic obstruction or leakage caused by malignancy. Non-malignant causes include postoperative trauma, cirrhosis, tuberculosis, pancreatitis and filariasis. A variety of treatment options have been proposed for the management of chylous ascites; however, their effectiveness in idiopathic or primary form is unknown. Here we report a case of chylous acid rapidly resolved with the treatment of fasting, total parenteral nutrition and somatostatin analogue.

Frequency of eosinophilic esophagitis in patients with esophageal symptoms: a single‐center Turkish experience

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized with symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. There has been a dramatic increase in the diagnosis of this disease in recent years. The primary objective of this study was to determine the frequency of EoE in adult patients who were evaluated by gastroenterologists in our clinic with esophageal symptoms. Between November 2010 and May 2011, 311 adult patients who were evaluated in our clinic with esophageal symptoms were enrolled prospectively. All patients underwent endoscopy and had biopsies taken. Gastroesophageal reflux disease was excluded by either proton pump inhibitory treatment or 24-hour ambulatory pH monitorization. The diagnosis was confirmed by one independent pathologist. Frequency of EoE in patients with esophageal symptoms was 2.6% (n = 8; four men and four women). Mean age at diagnosis was 40.2 ± 8 years. Heartburn was the predominant symptom in patients (75% of the patients), and 87.5% (n = 7) of patients had more than one symptom at diagnosis. Nearly 38% of the patients (n = 3) had a history of allergic disease. Endoscopic findings were as follows: transient/fixed esophageal rings (25%), white exudates (25%), and normal appearance (50%). Median number of circulating eosinophils was 208 (93-659)/mm(3) . Median number of intraepithelial eosinophils in proximal-middle 1/3 part and distal 1/3 part of esophagus were 0 (0-50)/hpf and 37 (16-50)/hpf, respectively. In conclusion, EoE is not rare in Turkey, and it should be considered in the differential diagnosis of patients with esophageal symptoms.

Effect of HLA on hepatitis C virus clearance and persistence in anti-HCV-positive end-stage renal disease patients

Background/Aims: The efficacy of immune response against hepatitis C virus (HCV) is determined by human leukocyte antigen (HLA) molecules of the host which present HCV antigens to CD4 + and CD8 + T lymphocytes. In this study, we aimed to investigate the possible relationship between the frequencies of certain HLA class I–II alleles and the natural history of HCV in patients with end-stage renal disease (ESRD). Settings and Design: This is a retrospective cohort study conducted in a university hospital. Patients and Methods: The present study comprised 189 ESRD patients (candidates for renal transplantation) who had positive anti-HCV antibody test. The results concerning HCV and HLA status were gathered from patients’ files. The viral persistence was compared between the groups that were determined by HLA sub-typing. Statistical Analysis: Statistical evaluation was performed using Mann–Whitney U-test, Chi-square test, and Fishers exact test. Level of error was set at 0.05 for all statistical evaluations, and P values < 0.05 were considered statistically significant. Results: We found possible association between the course of HCV infection and specific HLA alleles. HLA class I Cw*6 and HLA class II DRB*10 alleles were observed more frequently in the viral clearance group (P < 0.05). The HLA class I B*38 allele group was more prone to develop chronic hepatitis C (P < 0.01). Conclusions: These findings suggest that HLA class I Cw*6 and HLA class II DRB*10 alleles may be associated with immunological elimination of HCV in Turkish patients on hemodialysis. HLA sub-typing could help predict the prognosis of HCV infection.

An Unexpected Cause of Hyperactive Delirium in Patients with DecompensatedNonalcoholic Cirrhosis

Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad spectrum of differential diagnosis dominated by mental disorders. The prevalence of delirium in elderly patients admitting to hospital is 5-55% [1]. Delirium is a common neuropsychiatric syndrome that may occur in several different settings and one of them is vitamin B12 deficiency. Vitamin B12 deficiency causes many cerebral cortex abnormalities such as confusion, mood and memory changes, delirium with or without hallucinations, depression and acute psychotic states [2,3]. Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The clinical manifestations of HE is characterized by cognitive and motor deficits of varying severity without specific lesions in the central nervous system. The symptoms range from minimal changes in personality to coma, including delirium [4]. Usually, in the elderly patients with cirrhosis, it is hard to differentiate two clinical situations. Here we report a case of an elderly patient with cirrhosis who experienced delirium due to vitamin B12 deficiency, but was treated as HE before.

Transjugular intrahepatic portosystemic shunt: where are we?

BACKGROUND/AIMS The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/ hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients. MATERIALS AND METHODS Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7±18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively. RESULTS The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5±5.3 mm Hg to 9±2.7 mm Hg (p<0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p>0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (≥40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p<0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively. CONCLUSION Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.

A non-obstructive gastric antral web case detected after upper gastrointestinal system bleeding

Congenital or acquired gastric antral webs (GAWs) may cause gastric-outlet obstruction in children and adults. Endoscopic methods are often used in the treatment of obstructive GAWs. We report the case of a patient with a congenital non-obstructive antral gastric web. The patient was a 25-year-old male with gastrointestinal hemorrhage followed by dyspeptic complaints. There was a follow-up period for the patient after treatment. Because GAWs are encountered and rarely reported in the literature, the images taken during endoscopic surgery of the patient, as a significant contribution to the literature, are also presented.

Meperidine Withdrawal Syndrome Associated with Low Dose Short Term Use

Analgesics, including opioids such as meperidine are used for treatment of abdominal pain caused by acute pancreatitis. Meperidine withdrawal syndrome is usually seen after long-term use. We present here an acute panceratitis patient who experienced meperidine withdrawal syndrome after short term use and treated successfully with tramadol and deksketoprofen.

Nadir bir hemotokezya olgusunda farklı bir tedavi yaklaşımı

Although hematochezia generally indicates bleeding from colonic lesions, serious hematochezia can result from the upper gastrointestinal system as well. Here, we report a rare but serious case of upper gastrointestinal hemorrhage from a cardiac polyp presenting with hematochezia. The patient was successfully treated with endoscopic band ligation.

Lansoprazole-induced acute pancreatitis.

A 60-year old male patient was admitted to our emergency department complaining of nausea, vomiting, and abdominal pain. Lansoprazole (Lansor; Sanovel, İstanbul, Turkey) was prescribed to resolve these dyspeptic complaints. However, he suffered from abdominal pain, high fever, nausea, and vomiting an additional two times in the following two weeks. He discontinued treatment since he thought that the symptoms may have been caused by lansoprazole. After he stopped taking the drug, his symptoms decreased and eventually disappeared. During his third hospital admission with the same symptoms, physical examination revealed widespread abdominal tenderness and guarding with decreased bowel sounds. Laboratory test results were compatible with a diagnosis of acute pancreatitis. His electrocardiogram was normal. Computed tomography of the abdomen revealed a slightly enlarged pancreatic corpus and peripancreatic fluid, both of which were compatible with a diagnosis of acute panreatitis (Baltazar A-B level). His current history and laboratory test results eliminated other etiologies, such as viral infections, trauma, alcohol, or toxic causes.