Bleeding due to slippage of elastic band during variceal ligation: successful use of Ankaferd blood stopper.

Ankaferd blood stopper (ABS) is a hemostatic agent that induces clot formation by a special protein network which mainly causes powerful erythrocyte aggregation. The use of topical ABS as a hemostatic agent has been approved in Turkey for the management of dermal, external post-surgical and postdental surgery bleeding. ABS has been successfully used in Dieulafoy lesion and bleeding from gastrointestinal neoplasms. We present a patient with alcoholic cirrhosis who developed severe bleeding during an elective endoscopic variceal ligation (EVL) session due to immediate band slippage, in whom endoscopic topical application of ABS was associated with cessation of bleeding. The major advantages of ABS appear to be ease of use and lack of side effect.

Mutations in the S gene region of hepatitis B virus genotype D in Turkish patients.

The S gene region of the hepatitis B virus (HBV) is responsible for the expression of surface antigens and includes the 'a'-determinant region. Thus, mutation(s) in this region would afford HBV variants a distinct survival advantage, permitting the mutant virus to escape from the immune system. The aim of this study was to search for mutations of the S gene region in different patient groups infected with genotype D variants of HBV, and to analyse the biological significance of these mutations. Moreover, we investigated S gene mutation inductance among family members. Forty HBV-DNA-positive patients were determined among 132 hepatitis B surface antigen (HbsAg) carriers by the first stage of seminested PCR. Genotypes and subtypes were established by sequencing of the amplified S gene regions. Variants were compared with original sequences of these serotypes, and mutations were identified. All variants were designated as genotype D and subtype ayw3. Ten kinds of point mutations were identified within the S region. The highest rates of mutation were found in chronic hepatitis patients and their family members. The amino acid mutations 125 (M -> T) and 127 (T -> P) were found on the first loop of 'a'-determinant. The other consequence was mutation inductance in a family member. We found some mutations in the S gene region known to be stable and observed that some of these mutations affected S gene expression.