Şebnem Gürsoy

Tigecycline for the treatment of Clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients

Tigecycline for the treatment of Clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients Gökhan Metan, Zeynep Türe, Leylagül Kaynar, Elife Berk, Şebnem Gürsoy, Emine Alp, Hüseyin Kılıç, Mustafa Çetin Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Gastroenterology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey

Colonic Involvement in Fabry Disease

Figure 1. (A) Colon mucosa with normal histology at lower magnification (hematoxylin and eosin, 40×). (B) Photomicrograph showing vacuolization of the ganglion cells in the submucosa at higher magnification (hematoxylin and eosin, 400×). (c) Neurofilament positivity in vacuolated ganglion cells (400×) A 27-year-old male patient was admitted to the gastroenterology clinic with episodic diarrhea for 2 years. His medical history was notable for plasma α-galactosidase level of <0.1 nmol/h/mL (normal = 4-21.9) in an outside hospital in 2010. Physical examination and laboratory tests were unremarkable on admission. Upper endoscopy and colonoscopy revealed normal results. Light microscopy of the rectal biopsies showed vacuolization of the nerves and ganglion cells in the submucosa, whereas lamina propria and crypts were normal (Figure 1A and Figure 1B). Immunohistochemical studies with CD56, NSE, neurofilament, and S-100 confirmed the neuronal origin of the vacuolated cells (Figure 1C). Fabry disease is a rare X-linked inherited lysosomal storage disorder, and it is characterized by the deficiency of α-galactosidase A. Fabry disease is a multiorgan disorder and affects various systems of the body. The most frequent presentation of Fabry disease is neurological manifestations. The other clinical manifestations include gastrointestinal, renal, dermatological, cardiac, and auditory. Gastrointestinal symptoms include postprandial abdominal pain, nausea, vomiting, diarrhea, and altered bowel habits. Gastrointestinal presentations of the patients with Fabry disease are usually nonspecific. The lack of this enzyme results in accumulation of glycophospholipids in the nerve and ganglion cells and formation of myelin-like inclusion bodies. Glycophospholipid deposition is mainly found in the rectum and small bowel. Histologically, it is characterized by enlarged and vacuolated neurons. Endothelial cells and muscle cells have also been shown to be involved. Immunohistochemical studies in our case proved the deposition in myenteric plexus and nerve cells. Despite the frequency of the gastrointestinal tract involvement, patients are usually underdiagnosed because of the nonspecific nature of the gastrointestinal symptoms. Unexplained gastrointestinal symptoms should be interpreted by deep endoscopic biopsies including submucosa.

A Prospective, randomized study comparing 7-day and 14-day quadruple therapies as first-line treatments for helicobacter pylori infection in patients with functional dyspepsia

Objective: Standard triple therapy for Helicobacter pylori has a low eradication rate in Turkey. The aim of this study was to evaluate and compare the effectiveness of 7-day and 14-day lansoprazole, amoxicillin, clarithromycin, and bismuth subsalicylate (LACB) treatment regimens as first-line H. pylori eradication therapies. Materials and Methods: This study included 70 patients with symptoms of dyspepsia and a positive H. pylori stool antigen test (SAT). Thirty-five patients received the modified quadruple therapy regimen for 7 days (LACB-7) whereas the remaining 35 patients received the treatment for 14 days (LACB-14). Eradication was assessed by SAT 1 month after the end of therapy. Results: A total of 64 patients completed the therapy. The cumulative per-protocol (PP) and intention-to-treat (ITT) eradication rates were 89% (n = 57/64) and 81.4% (n = 57/70), respectively. Both the PP and ITT eradication rates were superior in the LACB-14 group, compared with the LACB-7 group (PP: 90.6% vs. 87.5%; ITT: 81.4% vs. 80%, respectively), but these differences were not statistically significant (P = 0.689). Conclusions: Both the 7-day and 14-day first-line LACB therapies provided a high cure rate, were well tolerated, and were equally effective against H. pylori infection in Turkey.

The role of endobronchial and endoscopic ultrasound guided fine needle aspiration for mediastinal nodal staging of non-small-cell lung cancer

Introduction Mediastinal and hilar nodal staging is one of the key points for differentiating treatment modalities in patients with non-small-cell lung cancer (NSCLC). The aim of the present study was to determinate the diagnostic yields of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and combined EBUS-TBNA and EUS-FNA modalities for nodal staging in potentially operable NSCLC patients. Materials and Methods Twenty consecutive patients were prospectively enrolled in the study between March 2014 and November 2015. All patients had a potentially operable NSCLC diagnosis before endosonographic procedures. Result Thirty lymph nodes were sampled by EBUS-TBNA and 17 lymph nodes were sampled by EUS-FNA in all 20 patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of F-18 fluorodeoxyglucose positron emission tomography with computed tomography (PET-CT), EBUS-TBNA, EUS-FNA and combined EBUS-TBNA and EUS-FNA were 100%, 33.3%, 64.7%, 100% and 70.0%; 81.8%, 100%, 100%, 81.8% and 90%; 81.8%, 100%, 100%, 75% and 88.2%; 90.9%, 100%, 100%, 90.0% and 95.0%, respectively. Conclusions The combined EBUS-TBNA and EUS-FNA technique is a successful procedure for nodal staging in potentially operable NSCLC patients.

Ipilimumab-associated cholestatic hepatitis: a case report and literature review

Ipilimumab is a monoclonal antibody that exerts its effects by inhibiting the cytotoxic T-lymphocyte-associated protein 4 receptor on cytotoxic T lymphocytes. It is frequently used for the treatment of unresectable or metastatic melanoma. Ipilimumab may lead to several immune-related disease including colitis, thyroiditis, pneumonia, hepatitis, or pancreatitis as a side effect. Limited number of cases with hepatic damage as an ipilimumab-related adverse event has been reported in the literature. This agent has been implicated in causing acute hepatitis-like liver injury. Here, we presented a case in which cholestatic hepatitis developed during ipilimumab use for the treatment of metastatic melanoma.