Sehmus Olmez

Multicenter epidemiologic study on hepatocellular carcinoma in Turkey.

BACKGROUND Hepatocellular cancer (HCC) is one of the important health problems in Turkey, being very common and highly lethal. The aim of this study was to determine clinical, demographic features and risk factors. MATERIALS AND METHODS Nine hundred and sixth-three patients with HCC from 13 cities in Turkey were included in this study. RESULTS Only 205 (21%) of the 963 patients were women, with a male:female predominance of 4.8:1 and a median age of 61 years. The etiologic risk factors for HCC were hepatitis B in 555 patients (57.6%), 453 (81%) in men, and 102 (19%) in women, again with male predominance, hepatitis C in 159 (16.5%), (14.9% and 22.4%, with a higher incidence in women), and chronic alcohol abuse (more than ten years) in 137 (14.2%) (16.8% and 4.9%, higher in males). The Child-Pugh score paralleled with advanced disease stage amd also a high level of AFP. CONCLUSIONS According to our findings the viral etiology (hepatitis B and hepatitis C infections) in the Turkish population was the most important factor in HCC development, with alcohol abuse as the third risk factor. The Child-Pugh classification and AFP levels were determined to be important prognostic factors in HCC patients.

The Prevalence of Gastric Intestinal Metaplasia and Distribution of Helicobacter pylori Infection, Atrophy, Dysplasia, and Cancer in Its Subtypes

Objectives. Gastric intestinal metaplasia (IM) is frequently encountered and is considered a precursor of gastric adenocarcinoma. In the Van region of Turkey, gastric adenocarcinoma incidence is high but the prevalence of gastric IM is not known. Helicobacter pylori (H. pylori) infection is a main factor leading to atrophy, IM, and cancer development in the stomach. The aim of the current study was to investigate the prevalence of IM and its subtypes and the prevalence of H. pylori infection, atrophy, dysplasia, and cancer in gastric IM subtypes. Materials and Methods. This retrospective study was conducted on 560 IM among the 4050 consecutive patients who were undergoing esophagogastroduodenoscopy (EGD) with biopsy between June 2010 and October 2014. Clinical records and endoscopic and histopathologic reports of patients with IM were analyzed. Results. The prevalence of gastric IM was 13.8%. The prevalence of incomplete IM was statistically significantly higher than complete IM. Type III IM was the most frequent subtype. Conclusions. Gastric IM is a common finding in patients undergoing EGD with biopsy in this region. High prevalence of incomplete type IM, especially type III, can be associated with the high prevalence of gastric cancer in our region.

The Syndrome of Inappropriate Secretion of AntiDiuretic Hormone in Patients With Brucellosis.

Various studies have shown that a number of infectious disease causes syndrome of inappropriate antidiuretic hormone (SIADH). However, the relationship between infectious disease and SIADH is not yet fully known. In this prospective study, we aimed to assess the presence of SIADH in patients with brucellosis.

Diffuse nodular lymphoid hyperplasia of the small bowel associated with common variable immunodeficiency and giardiasis: a rare case report

SummaryDiffuse nodular lymphoid hyperplasia (DNLH) of the intestine is an extremely rare lymphoproliferative disorder of uncertain etiology. Typically, numerous polypoid nodules composed of hyperplastic benign lymphoid tissue are present in the small and/or large intestinal mucosa. DNLH has been observed in association with common variable immunodeficiency (CVID). A 38-years-old man was admitted to our clinic due to dyspeptic complaints. An upper gastrointestinal system endoscopic examination revealed DNLH in the duodenum. A biopsy specimen showed the presence of nodular lymphoid hyperplasia and a Giardia lamblia infection in the duodenum. CVID was suspected, and the diagnosis was established by demonstrating a significant reduction in the serum gamma-globulin levels. DNLH is a rare benign condition with regards to diagnosis and treatment of unknown etiology. In patients with DNLH, screening for the immune deficiencies is being important in addition to histopathological examinations.ZusammenfassungDie diffuse noduläre lymphoide Hyperplasie (DNLH) des Darms ist eine extrem seltene lymphoproliferative Erkrankung ungesicherter Ätiologie. Typisch für die Erkrankung sind zahlreiche polypoide Knoten in der Mukosa des Dünn- und/oder Dickdarms, die aus benignem hyperplastischem lymphoiden Gewebe bestehen. Es liegen Berichte über ein mit gewöhnlicher passagerer Immundefizienz (CVID) gemeinsames Auftreten vor.Ein 38-jähriger Patient wurde auf unserer Klinik wegen dyspeptischer Beschwerden aufgenommen. Eine Gastro-Duodenoskopie ergab das Vorliegen einer DNLH im Duodenum. Im bioptischen Material wurde eine noduläre lymphoide Hyperplasie, sowie eine Infektion mit Giardia lamblia festgestellt. Eine suspizierte CVID wurde durch den Nachweis einer signifikant verminderten Gammaglobulinämie bestätigt.Was die Diagnose und Therapie betrifft, ist die DNLH eine seltene benigne Erkrankung – allerdings unklarer Ätiologie. Bei Patienten mit DNLH sollte zusätzlich zur Histologie ein Screening auf Immundefizienz durchgeführt werden.

The relationship between liver histology and noninvasive markers in primary biliary cirrhosis.

Background Primary biliary cirrhosis (PBC) is a disease that affects liver with various severity and progression rates. It is important to diagnose advanced stage of the disease to lower liver-related morbidity and mortality. Since liver biopsy is an invasive method, liver biopsy tends to be replaced by noninvasive methods. In this study, we aim to show the role of aminotransferase to platelet ratio index (APRI) and fibrosis index on the basis of the four factors (FIB-4) scores, laboratory values, and their effectiveness in predicting advanced disease. Materials and methods PBC patients diagnosed pathologically at Numune Education and Research Hospital were included in the study between the years 1995 and 2013. Patients were grouped according to their fibrosis level: group 1 (early stage) included 18 patients with F1 and F2 fibrosis and group 2 (advanced stage) included 22 patients with F3 and F4 fibrosis. APRI and FIB-4 scores, routine laboratory values, and their proportions were compared. The effectiveness of parameters showing advanced stage was further compared. Results There were statistically significant differences in APRI, FIB-4 scores, and aspartate aminotransferase (AST) levels between the groups with early and advanced stages of disease. Receiver operating curve analysis was used to determine APRI, FIB-4 and AST levels. The most effective parameters for diagnosing an advanced stage were APRI, AST levels, and FIB-4 scores, respectively. Conclusion In conclusion, APRI and FIB-4 scores can be calculated simply and easily by routine laboratory tests at low cost and also these scores may be a predictor of advanced stage of the disease in PBC. These tests may be reproducible and may be used to monitor disease progression.

Glycogenic Hepatopathy in Type 1 Diabetes Mellitus.

Glycogenic hepatopathy is a rare cause of high transaminase levels in type 1 diabetes mellitus. This condition, characterized by elevated liver enzymes and hepatomegaly, is caused by irreversible and excessive accumulation of glycogen in hepatocytes. This is a case report on a 19-year-old male case, diagnosed with glycogenic hepatopathy. After the diagnosis was documented by liver biopsy, the case was put on glycemic control which led to significant decline in hepatomegaly and liver enzymes. It was emphasized that, in type 1 diabetes mellitus cases, hepatopathy should also be considered in the differential diagnoses of elevated liver enzyme and hepatomegaly.

Update on the effect of age on acute pancreatitis morbidity: a retrospective, single-center study

Introduction Acute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing. Aim To evaluate the contributing factors of mortality in geriatric patients (age ≥ 65 years) and non-geriatric (age < 65 years) patients. Material and methods We retrospectively analyzed data of consecutive patients with AP, in the Adana Numune Education and Research Hospital between March 2013 and September 2015. Results Of the 602 patients studied, 405 were female and 197 were male and their mean age was 55.2 ±19.5 years. The most common etiological factors were biliary stone, hyperlipidemia and alcohol, respectively. Two hundred and four patients were in the geriatric group and 394 patients were in the non-geriatric group. 84.4% of patients had mild AP, and 15.6% of patients had moderate to severe AP according to the revised Atlanta classification. 91.7% of non-geriatric patients had mild AP while 70.7% of geriatric patients had mild AP (p < 0.001). 29.4% of geriatric patients had moderate-to-severe AP while 8.4% of non-geriatric patients had moderate-severe AP. Duration of hospital stay was 6.2 ±3 days and 5.3 ±2.3 days in geriatric and non-geriatric groups respectively (p < 0.001). Mortality was higher in the geriatric group than the non-geriatric group (9.6% vs. 0.5%, respectively) (p < 0.001). Conclusions Acute pancreatitis in the geriatric population shows a more severe course than the non-geriatric population. Geriatric patients have longer duration of hospital stay and higher mortality than non-geriatric patients.

Treatment of Esophageal Strictures with Savary-Guilliard Bougies

Objective: Esophageal strictures may be caused by benign or malign disorders. Benign strictures are peptic stricture, Schatzki’s ring, esophageal web, and caustic ingestion, post-radiotherapy or post-surgical strictures. Dilatation with Savary-Guilliard bougies (SGD) is the most common endoscopic treatment of choice. In this study, we aimed to investigate the effectiveness of dilatation with Savary-Guilliard Bougies (SGB). Methods: We retrospectively analyzed the cases treated with SGD in Ankara Numune Education and Research Hospital between October 2005 and June 2011. All the demographic and clinical datas were recorded as well as endoscopic dilatation count and complications. Results: 73 patients (33(45.2%) males and 40 (54.8%) females) involved in the study. Mean age was 55,6±15,7(18-90) years old. A total of 536 dilatations of 73 patients performed in 169 sessions. Mean sessions of SGD 2,3±2.9(1-21) and dilatation counts were 7.4±9.4(1-65). The most seen etiologies were esophageal web (n=14, 19.2%), post-radiotherapy (n=14, 19.2%), anastomotic strictures (n=11, 15.1%) ingestion of corrosive substances (n=9, 12.3%) and malign strictures (n=8, 11%). The most seen benign causes and session counts were compared. Strictures secondary to radiotherapy and ingestion of caustic substances were the most common conditions treated with SGD. A single session was sufficient in strictures caused by esophageal web. No major complications such as perforation, major bleeding or sepsis were observed. Conclusion: SGD for the treatment of esophageal benign strictures is a safe, cheap, easily performed method without need for fluoroscopy. While treatment of esophageal web is usually treated with a single session, repeated endoscopic dilation sessions are required for the strictures caused by radiotherapy and corrosive ingestion.

AN UNEXPECTED GUEST IN THE STOMACH: TAENIA SAGINATA.

ENDOSCOPY NURSING It is unusual to see Taenia saginata located in the stomach. We present a case of living T. saginata incidentally discovered by upper gastrointestinal endoscopy. A 60-year-old female patient was admitted to the hospital, after ingesting a corrosive substance accidentally. Her physical examination was normal and laboratory values were within normal limits. She had a history of dyspeptic complaints for the past 2 years. She was given proton pump inhibitor therapy and parenteral hydration. Two days later, an endoscopy was performed and it revealed pangastritis and a live tapeworm, extending from corpus through the third portion of duodenum ( Figure 1 ). The tapeworm was grasped by a tripod and removed perorally. It measured 100 cm in length and diagnosed as T. saginata by a parasitologist. After giving a single dose of niclosamid, the scolex and proglottids were seen in the stool. The beef tapeworm is a common infection of both humans and cattle in Turkey. Its prevalence is unknown. It is estimated that 50 million people AN UNEXPECTED GUEST IN THE STOMACH: TAENIA SAGINATA

Esophageal Lymphoepithelioma-Like Carcinoma with Unique Daisy-Like Appearance

Due to differences in prognosis and management, it is important to subclassify esophageal carcinoma. Esophageal lymphoepithelioma-like carcinoma (LELC) is extremely rare, with only a few cases reported to date. Review of the literature revealed case reports describing lesions with similar histology. We present a 69-year-old man with a giant pedunculated-polypoid lesion of the esophagus shrinking the lumen. Endoscopic excision of the tumor was performed and final histopathological diagnosis was confirmed to be LELC. In contrast to a previous case with a more aggressive course and a recurrent lesion, our patient died of his disease within 8 months of diagnosis. Here we discuss the endoscopic and radiologic findings of the case and a review of the literature.