Vedat Göral

A Case of Biliary Fascioliasis by Fasciola gigantica in Turkey

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.

Seroprevalence of Hepatitis B and C Viruses in Patients with Chronic Kidney Disease in the Predialysis Stage at a University Hospital in Turkey

Background: Hepatitis B (HBV) and C (HCV) viruses are the most common viruses that cause viral infections among the hemodialysis patients. Objectives: To assess the prevalence of HBV and HCV in predialytic chronic kidney disease (CKD) patients. Design: A cross-sectional study. Subjects: 171 consecutive predialytic CKD patients. Measurements: Third-generation micro-ELISA assay was used for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core (anti-HBc) and surface antibody (anti-HBs), secretory form of hepatitis B envelop antigen (HBeAg), antibody to secretory form of hepatitis B envelop antigen (anti-HBe), and ELISA for antibody to hepatitis C virus (anti-HCV). Results: The main causes of CKD were 29.8% diabetic nephropathy, 19.9% chronic glomerulonephritis, 16.3% hypertensive nephrosclerosis, 14.0% unknown, 5.3% amyloidosis, 4.7% autosomal-dominant polycystic kidney disease, 4.1% chronic tubuluointerstitial nephritis, 3.5% malignancies, 1.7% benign prostatic hypertrophy, 0.6% Alport syndrome. The seroprevalence of hepatitis was: HBsAg 10.5%, anti-HBc 36.8%, anti-HBs 28.7%, HBeAg 5.3%, anti-HBe 32.7%, anti-HCV 7% and HBsAg+anti-HCV 0.6%. Conclusions: The seroprevalence of HBsAg and anti-HCV among predialytic CKD patients was similar to our patients in hemodialysis program.

Malignant melanoma of the stomach presenting in a woman: a case report

IntroductionMalignant melanoma is reported to metastasize to all organs of the human body. Although it is common for it to metastasize to the gastrointestinal tract, a melanoma located primarily in the gastric mucosa is an uncommon tumor. Gastrointestinal metastases are rarely diagnosed before death with radiological and endoscopic techniques.Case presentationIn this case report the clinical course and treatment of a woman with melanoma of the stomach, without any other detectable primary lesion, is presented and discussed. A 55-year-old Turkish woman presented to our clinic with complaints of muscle pain and bone pain in the left side of her chest. During an upper gastrointestinal system endoscopy, dark cherry-colored, light elevated, round-shaped lesions were taken from her gastric fundus and from the first part of her duodenum. Biopsies from these samples were determined to be malignant melanoma by the pathologist.ConclusionMetastatic malignant melanoma cases should be examined through endoscopy for gastrointestinal metastases.

Correlation of Disease Activity, IL-6 & CRP Levels and Leukocytes/Lymphocyte Ratio Among Patients with Acute Pancreatitis

Introduction and aim: The aim of this trial is to investigate whether the comparison of Ranson, APACHE II and Balthazar scoring systems with inflammatory mediators CRP, leukocytes/lymphocytes ratio and IL-6 are statistically significant. Material and method: A total of 52 patients were enrolled in this trial. Ranson and APACHE II scores and serum CRP, leukocytes/lymphocytes ratio and interleukin-6 (IL-6) levels were determined in all patients. In all patients with severe AP, abdominal CT was performed in accordance with Balthazar scoring system. Results: According to correlation of AP scoring and inflammatory mediators, statistical significance was found for correlation of APACHE II with CRP and Ranson scores (P<0.001). Correlation of CRP with Ranson score and IL-6 was statistically significant (P<0.001), a significant correlation was determined between Ranson score and IL-6 (P: 0.014). Leukocytes/lypmhocyte ratio was 12.71 (1.95 ± 34.7) in patients with acute pancreatitis (normal ratio: 2.63) (P<0.001). CT examinations of severe AP cases were graded according to Balthazar scoring system; in Ranson, APACHE II scores and CRP, IL-6 values were found to be elevated, in parallel to increase in scores. Conclusion: According to our data, we suggest using the IL-6, CRP and leukocytes/lymphocytes ratio a simple indicator of severity in patients presenting with acute pancreatitis.

Vertical Transmission of Helicobacter pylori : Different Transmission Route

To the Editor:We report a patient with polymyositis who was subsequently found to have esophageal carcinoma, a rare association. A 50-yr-old man presented with progressive dysphagia to solid foods for 6 months. He had been admitted 4 yr ago with progressive proximal muscle weakness of all limbs. There was no history of skin rash, joint pains, oral ulcerations, Raynaud’s phenomenon, and photosensitivity. Neurological examination revealed normal higher mental functions and cranial nerves. There was wasting of shoulder and hip girdle, proximal muscle weakness of grade III/V, with normal power in distal muscle groups. Neck and trunk muscles were weak. Reflexes were normal with flexor plantar responses. There was no sensory impairment. His muscle enzymes were raised, and nerve conduction studies and electromyography had revealed a myopathic pattern. His muscle biopsy was consistent with chronic polymyositis. He was being treated with steroids and azathioprine but with no favorable response. Investigations revealed mild iron deficiency anemia, and normal liver and renal function tests. Collagen profile was normal. Upper GI endoscopy for dysphagia revealed a stricture at 33 cm. Brushings from stricture showed malignant cells. The association of polymyositis with malignant tumor has been known for many years. It was first described in 1916 (1). At times, it may be associated with more than one cancer (2). In the largest series to date (Sigurgeirsson et al.), 9% of 396 patients with polymyositis were found to have cancer, either at that time or within 5 yr of diagnosis of muscle disease (3). A high index of suspicion should be kept in elderly patients (4). It is more frequent in men than in women (3). In most of the cases, the clinical features of malignancy antedate or occur concurrently with polymyositis (5). The progression and regression of the muscle disease is in synchrony with the course of cancer. Although muscle weakness may lessen and serum enzyme levels decline in response to steroid therapy, they will reappear after a few months and may then become resistant to further treatment. A complete resolution of symptoms only occurs after treatment of the associated malignancy. The association of polymyositis and esophageal cancer is rare, and to our knowledge only one case report has been published so far (6).

Kronik HCV'li hemodiyaliz hastalarında occult HBV infeksiyonu sıklığı

Background/aim: Occult hepatitis B virus (HBV) infection is defined by the existence of HBV infection in which HbsAg cannot be determined. It is reported that the prevalence of occult HBV infection is high in chronic hepatitis C, HCC and hemodialysis patients, in patients having cryptogenic liver disease, in drug-injection users and those with HIV, as well as in those patients with blood transfusion and in blood donors. In this study, we aimed to investigate the prevalence of occult HBV infection in hemodialysis patients with chronic HCV and to establish its clinical effects. Materials and methods: A total of 50 chronic hemodialysis patients whose HbsAg was negative and anti-HCV positive were included in the study. According to the results of HCV-RNA polymerase chain reaction (PCR), these patients were divided into two groups: HCVRNA positive and HCV-RNA negative. In both groups, HBV-DNA was investigated by sensitive PCR method. Results: HBV-DNA could not be determined by PCR method in any of 22 patients in the HCV-RNA positive group and of 28 patients in the HCV-RNA negative group. The mean age of patients was 47.2±17 in the HCV-RNA positive group and 39.6±15.6 in the HCV-RNA negative group. Conclusion: The prevalence of occult HBV infection in hemodialysis patients with chronic HCV was determined not to be high in our area. This result in our study should be further evaluated by taking into account the interaction of HbsAg positivity rate (8-10%) with the prevalence of HBV mutants in the region. In addition, it is necessary to revise the sensitivity and specificity of still non-standardized HBV-DNA PCR methods and determine a common diagnosis method accordingly.