Changing trends in the etiology of liver transplantation in Turkiye: A multicenter study.

Background and Aim: This study aimed to identify the indications for liver transplantation (LT) based on underlying etiology and to characterize the patients who underwent LT. Materials and Methods: We conducted a multicenter cross-sectional observational study across 11 tertiary centers in Turkiye from 2010 to 2020. The study included 5,080 adult patients. Results: The mean age of patients was 50.3±15.2 years, with a predominance of female patients (70%). Chronic viral hepatitis (46%) was the leading etiological factor, with Hepatitis B virus infection at 35%, followed by cryptogenic cirrhosis (24%), Hepatitis C virus infection (8%), and alcohol-related liver disease (ALD) (6%). Post-2015, there was a significant increase in both the number of liver transplants and the proportion of living donor liver transplants (p<0.001). A comparative analysis of patient characteristics before and after 2015 showed a significant decline in viral hepatitis-related LT (p<0.001), whereas fatty liver disease-related LT significantly increased (p<0.001). Conclusion: Chronic viral hepatitis continues to be the primary indication for LT in Turkiye. However, the proportions of non-alcoholic fatty liver disease (NAFLD) and ALD-related LT have seen an upward trend over the years.

Evaluation of fibrosis with noninvasive biochemical tests in chronic viral hepatitis B.

Background and Aim: Early diagnosis and treatment of chronic hepatitis B (CHB) disease are important for the prevention of complications such as cirrhosis and hepatocellular cancer. Liver biopsy is an invasive, complicated, and expensive diagnostic method, which is the gold standard for detecting fibrosis. The aim of this study was to investigate the role of these tests in predicting liver fibrosis and treatment decision. Materials and Methods: A total of 1051 patients diagnosed with CHB between 2010 and 2020 in the Gaziantep University Gastroenterology Department were retrospectively evaluated. AAR, API, APRI, FIB-4, KING score, and FIBROQ score were calculated at the time of onset diagnosis. In addition, the Zeugma score, a new formula that is thought to be more sensitive and specific, was determined. Noninvasive fibrosis scores were compared according to the biopsy results of the patients. Results: In this study, the area values under the curve were 0.648 for the API score, 0.711 for the APRI score, 0.716 for the FIB-4 score, 0.723 for the KING score, 0.595 for the FIBROQ score, and 0.701 for the Zeugma score (p<0.05). No statistically significant difference was obtained for the AAR score. The KING, FIB-4, APRI, and Zeugma scores were the best indicators for detecting advanced fibrosis. For KING, FIB-4, APRI, and Zeugma scores, the cutoff value for the prediction of advanced fibrosis were ≥8.67, ≥0.94, ≥16.24, and ≥9.63 with a sensitivity of 50.52%, 56.77%, 59.64%, and 52.34%, specificity of 87.26%, 74.96%, 73.61%, and 78.11%, respectively (p<0.05). In our study, we compared the globulin and GGT parameters with fibrosis, which we used in the Zeugma score formula. Globulin and GGT mean values were significantly higher in the fibrosis group (p<0.05). There was a statistically significant correlation between fibrosis and globulin and GGT values (p<0.05, r=0.230 and p<0.05, r=0.305, respectively). Conclusion: The KING score was found to be the most reliable method for the noninvasive detection of hepatic fibrosis in patients with chronic HBV. The FIB-4, APRI, and Zeugma scores were also shown to be effective in determining liver fibrosis. It was shown that the AAR score was not sufficient for detecting hepatic fibrosis. The Zeugma score, a novel noninvasive test, is a useful and easy tool to evaluate liver fibrosis in patients with chronic HBV and has better accuracy than AAR, API, and FIBROQ.

Changes in Hepatitis C Awareness in Different Disciplines During COVID-19.

BACKGROUND: We aimed to determine the awareness of referring hepatitis C virus patients to the relevant departments and the effect of the pandemic period on this subject. METHODS: A total of 65 743 patients with anti-hepatitis C virus requests before and during the COVID-19 pandemic were retrospectively screened. Anti-hepatitis C virus-positive patients were divided into 5 groups according to age distribution. The distribution of patients with anti-hepatitis C virus positivity was compared according to age groups, before and during COVID-19. Anti-hepatitis C virus-pos- itive patients who were not requested hepatitis C virus RNA were evaluated individually according to the departments, and hepatitis C virus awareness was compared before and during COVID-19. RESULTS: Anti-hepatitis C virus positivity rate was 1.54% before COVID-19; this rate was 2.15% during COVID-19. When the anti-hep- atitis C virus positivity rate was compared in terms of age distribution according to before and during COVID-19, it was observed that there was a statistically significant decrease in the >65 age group in the COVID-19 period (P = .004). It was found that 216 (32%) of the patients who had anti-hepatitis C virus (+) before COVID-19 and 231 (48.1%) of the patients during COVID-19 were not requested hepatitis C virus RNA test (P < .0001). The departments with the highest awareness of hepatitis C virus were gastroenterology, infec- tious diseases, hematology, gynecology and obstetrics, and oncology, while the departments with the lowest hepatitis C virus awareness were ophthalmology, psychiatry, and general surgery. It was found that chronic hepatitis C virus awareness decreased in all departments during COVID-19. CONCLUSION: Hepatitis C virus awareness has decreased in all medical departments despite the physician alert system during COVID-19 and also the rate of anti-hepatitis C virus (+) patients decreased in the group aged >65 years during the pandemic.

Lymphocyte to Monocyte Ratio and C-Reactive Protein Combination as the Best Simple Predictor of Treatment Response in Cirrhotic Patients with Culture Negative Neutrocytic Ascites.

Objectives: The aim of this study was to evaluate the most ideal inflammatory markers for treatment response and to determine a cutoff value that could predict response to treatment for culture negative neutrocytic ascite (CNNA) patients. Methods: This is a retrospective cross-sectional case-controlled study. Patients with CNNA were evaluated by taking ascites fluid sampling at the beginning and on the 5th day of treatment. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-monocyte ratio were calculated. Results: Of the 123 cases with cirrhotic ascites disease, 59 were CCNA and 64 were the control group without ascite-fluid infection. There were statistically significant differences for blood monocyte count, NLR (p<0.01), LMR, and C-reactive protein (CRP) (p<0.001) between two groups. Patients in the CNNA group were compared before and after treatment among themselves for the treatment response. There was statistically significant difference in mean platelet volume, monocyte, LMR, and CRP (p<0.05) between two groups. After receiver operator characteristics curve analysis, the best cutoff value for monocyte was <0.64 × 103/µL (sensitivity 49.2%, specificity 74.6%, positive predictive value [PPV] 65.9%, and negative predictive value [NPV] 59.5%) (p<0.01), for LMR was ≥1.7 (sensitivity 76.3%, specificity 78%, PPV 77.6%, and NPV 76.7%), and for CRP was ≤18 mg/L (sensitivity 91.5% specificity 57.6%, PPV 68.4%, and NPV 87.2%) (p<0.001). When LMR and CRP were used together, sensitivity (86.5%), specificity (83.1%), PPV (83.6%), and NPV (86%) were found to be statistically significantly higher (p<0.001). Conclusion: Our results showed that in cirrhotic patients with CNNA, combined LMR + CRP can be used as a novel, low cost and non-invasive test to predict treatment response.

Treatment of HCV infection with direct-acting antiviral agents. Real life experiences from the Euro-Asian region.

BACKGROUND/AIMS: Hepatitis C virus (HCV) infection is a common disease that causes liver cirrhosis, hepatocellular carcinoma, and extra hepatic manifestations with high mortality and morbidity rates. This study aimed to present real-life experiences and results of treatment of HCV infection with direct-acting antiviral agents (DAAs) from the Euro-Asian region, including Turkey and Azerbaijan. MATERIALS AND METHODS: A total of 1224 patients with chronic HCV infection were treated with DAAs in accordance with the international guidelines for the management of HCV infection. The mean age was 58.74±14.75 years, with 713 (58.25%) females. The genotypes of the patients were as follows: genotype 1b, 83.36% (n=1024); genotype 1a, 8.08% (n=99); genotype 2, 2.85% (n=35); genotype 3, 3.34% (n=41); genotype 4, 1.71% (n=21); and combined genotypes, 0.32% (n=4). Approximately 808 patients were treated with sofosbuvir-based DAAs with or without Ribavirin for 12 or 24 weeks, whereas 416 patients were treated with the Paritaprevir, Ombitasvir, Ritonavir.Dasabuvir (PROD) regimen with or without Ribavirin for 12 weeks or 24 weeks. RESULTS: At the end of follow-up examinations, 1183 patients (97.93%) had sustained virological response (SVR), 17 (1.40%) died of reasons unrelated to the treatment regimen, 12 had recurrence after treatment, and 129 (10.67%) had adverse events like anemia, itching, and weakness. CONCLUSION: In this large cohort of HCV-infected patients, treatment with DAAs yielded a high overall SVR rate of 97.93%. DAAs were safe and well-tolerated. Thus, the elimination of HCV infection is no longer a dream worldwide.

Prognostic factors in patients with advanced extrahepatic cholangiocarcinoma: A single center experience.

Extrahepatic cholangiocarcinoma (ECC) is an aggressive malignancy causing a lot of fatalities and comorbidities. Endoscopic biliary stenting (EBS) is mostly needed for ECC. In this study, we aimed to investigate the prognostic factors for the overall survival (OS) and the factors predicting the patients eligible for chemotherapy after EBS in ECC.We retrospectively screened 153 advanced ECC patients who underwent EBS for jaundice to make the patients eligible for chemotherapy. Patient's clinical and laboratory parameters were recorded. OS was estimated by the Kaplan-Meier method. All parameters were assessed by binary logistic regression analysis to predict which patients are eligible for chemotherapy.The median OS of all patients was 12.0 months (10.1-13.8). The median OS of the patients treated with chemotherapy was 13.0 months (12.0-14.0), while it was 4.0 months (2.3-5.7) for patients unable for chemotherapy after EBS. Albumin, aspartate aminotransferase (ALT) and carbohydrate antigen 19-9 (CA 19-9) values were independent prognostic factors for OS. Higher albumin and lower prothrombin time (PT) levels were independent parameters to predict the patients eligible for chemotherapy after EBS.Being suitable for chemotherapy was the main determinant for prolonged survival and albumin and PT levels were independent predictors for chemotherapy eligibility after EBS. Albumin, ALT, and CA 19-9 values were independent prognostic factors for OS in ECC.

Anterior Segment Parameters in Patients With Wilson Disease.

PURPOSE: To investigate anterior segment parameters in patients with Wilson disease (WD). METHODS: In this cross-sectional study, 22 patients with WD (study group) and 22 healthy subjects (control group) were enrolled. Each participant underwent a comprehensive ophthalmic assessment including best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, and intraocular pressure. Anterior segment parameters were measured by the Sirius anterior segment analyzer system (Costruzione Strumenti Oftalmici, Florence, Italy). RESULTS: Mean central corneal thickness was 522 ± 47 µm in the study group and 568 ± 37 µm in the control group (P < 0.001). Mean flat keratometry was 42.4 ± 1.7 diopter (D) in the study group and 41.5 ± 1.16 D in the control group (P = 0.011); mean steep keratometry was 43.4 ± 2.0 and 42.4 ± 1.4 D in the study and control groups, respectively (P = 0.025). The anterior corneal elevation value was 5.5 ± 3.2 µm in the study group and 4.08 ± 2.2 µm in the control group (P = 0.029); the mean posterior corneal elevation value was 15.1 ± 6.0 and 10.1 ± 4.1 µm in the study and control groups, respectively (P = 0.002). The mean anterior chamber depth was 2.97 ± 0.3 µm in the study group and 3.16 ± 0.3 µm in the control group (P = 0.01); the mean horizontal visible iris diameter was 11.9 ± 0.4 and 12.2 ± 0.4 µm in the study and control groups, respectively (P = 0.001). CONCLUSIONS: This study indicates that patients with WD have differences in the anterior segment parameters including central corneal thickness, keratometric values, anterior and posterior elevations, horizontal visible iris diameter, and anterior chamber depth when compared with healthy controls.

Study of ideal topical pharyngeal anesthesia in upper gastrointestinal system endoscopy: A double-blind, randomized, controlled trial.

BACKGROUND/AIMS: This study is designed to determine which drug forms provide ideal pharyngeal anesthesia when used during upper gastrointestinal system endoscopy. MATERIALS AND METHODS: A total of 180 patients were included in the study. Using the random number table, these patients were divided into three groups. Group 1, lidocaine gel+isotonic spray; Group 2, base lubricant gel+lidocaine spray; and Group 3: lidocaine gel+lidocaine spray. Data were collected from the patient identification form, compliance to operation form, and State Anxiety Inventory. RESULTS: Anesthetization and compliance to procedure scores were higher and anxiety scores were lower in Group 3 than in other groups (p<0.05). It was observed that as the compliance score increased, the anesthetization and satisfaction scores also increased; however, coughing during the procedure, duration of the procedure, and anxiety scores decreased (p<0.05). It was determined that as anesthetization scores increased, discomfort in the throat caused by the device, coughing during the procedure, and anxiety scores decreased (p<0.05). CONCLUSION: Lidocaine gel and spray combination is the most ideal pharyngeal anesthesia to ensure the adaptation of the patient to the procedure and to decrease anxiety and discomfort during the procedure.

The radio-protective effects of caffeic acid phenethyl ester and thymoquinone in rats exposed to total head irradiation.

BACKGROUND: Many cancer patients treated with radiotherapy suffer severe side effects during and after their treatment. The aim of this study was to investigate the effects of irradiation and the addition of caffeic acid phenethyl ester (CAPE) and thymoquinone (TQ) on the oxidant/antioxidant system in the liver tissue of irradiated rats. METHODS: A total of 40 Sprague-Dawley rats were divided into five groups to test the radioprotective effectiveness of thymoquinone and caffeic acid phenethyl ester administered by intraperitoneal injection. Appropriate control groups were also studied. RESULTS: While liver tissue total oxidant status, lipid hydroperoxide level, and oxidative stress index were significantly increased in the irradiated (IR) group, compared with other groups, total antioxidant status, sulfhydryl levels, and paraoxonase (PON) activity were significantly decreased. Ceruloplasmin activity in IR plus TQ and IR groups was higher than the control group. Arylesterase and PON activities in IR plus TQ- and IR plus CAPE-supplemented groups were lower than those of control groups. CONCLUSIONS: TQ and CAPE decrease oxidative stress markers and have antioxidant effects, which also augment antioxidant capacity in the liver tissue of irradiated rats.

Drug-induced esophageal ulcers: case series and the review of the literature.

BACKGROUNDS/AIMS: Drugs can cause several complications in the esophagus and lead to pill esophagitis. In this paper, our purpose is to share our clinical experience in light of the literature and put forward the general characteristics of pill esophagitis. MATERIALS AND METHODS: In our clinic, between January 2008 and June 2012, by excluding other factors, 48 patients were included in the study, diagnosed as drug-induced esophagitis with their history, endoscopic view, and histopathologic evaluation. RESULTS: There were 34 (70.9%) female and 14 (29.1%) male patients in the study, and their average ages were 35.1 and 32.4, respectively. Clinical symptoms were odynophagia (79.1%), retrosternal pain (62.5%), and dysphagia (47.9%). The reason for these symptoms for 85.5% of the patients was related to insufficient water consumption while taking the pill, taking the pill in recumbent position, or both. Tetracycline and its variant, doxycycline, were responsible for 52% of the patients, and 62.5% of the drugs were in capsule form. Ulcers were at the proximal and middle third of the esophagus in 79.2% of the patients. In the histopathologic evaluation, nonspecific acute inflammatory changes were found in 29.1% of the cases. Various proton pump inhibitors and sucralfate were used in the treatment. While no perforation and structure were detected, 1 patient died because of repetitive arterial bleeding. CONCLUSION: Almost every kind of drug, particularly doxycycline, can cause ulcer in the esophagus. Pill esophagitis can be prevented by warning patients about drinking water sufficiently and sitting up while taking the pill.

Lamivudine treatment failure risks in chronic hepatitis B patients with low viral load.

AIM: To analyze the risk factors of lamivudine treatment failure (LTF) for the long-term use in patients with low viral load (LVL). MATERIAL AND METHODS: In this multicenter study, 548 antiviral naïve noncirrhotic adult patients with LVL (for HBeAg+ patients HBV DNA <10 9 copies/ml and for HBeAg­patients HBV DNA <10 7 copies/ml) were enrolled. As a control group, 46 lamivudine-initiated patients with high viral load (HVL) were included. Primary outcome was switching to or adding on another antiviral drug as a consequence of primary nonresponse, partial response, viral breakthrough or adverse events. Secondary outcomes included LTF rates at 1, 2, 3, 4 and 5 years and LTF-related viral and host factors. RESULTS: Among 594 patients, 294 had to change lamivudine at the follow-up. Primary nonresponse, partial response, viral breakthrough or adverse events frequencies were 6.8, 1.6, 64.5 and 0.1%, respectively. Five-year LTF rates were 61.3 and 84.2% in patients with LVL and HVL, respectively. Among patients with LVL, patients with <100,000 copies/ml and ≥ 100,000 copies/ ml had 54.8 and 67.3% LTF rates at the end of the 5th year, respectively. Logistic regression analysis of risk factors showed HBeAg+, hepatic activity index, HBV DNA, virological response at 6 months and duration of follow-up were independent predictors for LTF (p values were 0.001, 0.008, 0.003, 0.020 and 0.003, respectively). CONCLUSION: Similar to patients with HVL, first-line lamivudine therapy is not efficient for long-term use in patients with LVL. LTF risk is so high even in the absence of worse predictive factors.

Long-term efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus-related cirrhosis.

BACKGROUND & AIMS: Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS: We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 ± 9.7 mo), 77 patients received entecavir (followed up for 24.0 ± 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 ± 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS: Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS: Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.

A rare case of portal vein gas: accidental hydrogen peroxide ingestion.

Hydrogen peroxide (H(2)O(2)) is a colourless and odourless liquid with oxidant characteristics used for various purposes. Whereas in lower concentrations (3%), H(2)O(2) is used as a disinfectant in home cleaning products and wound care, in higher concentrations (35%) it is used in textile and paper industry as a bleaching agent and is diluted for use in lightening hair dyes. Like other caustic substances, direct injuries may develop if H(2)O(2) is swallowed and systemic air embolisms may occur due to the resultant gaseous oxygen. This study discusses a patient who was detected with the presence of gas in the portal venous system due to H(2)O(2) intoxication and was treated conservatively.

Effect of providing information to the patient about upper gastrointestinal endoscopy on the patient's perception, compliance and anxiety level associated with the procedure.

BACKGROUND/AIMS: Diagnostic tests such as endoscopy are anxiety-provoking. The best intervention to reduce anxiety is to inform the patient about the procedure. Our study was conducted as a randomized controlled trial to determine the effect of providing information on the patient's perception of endoscopy, compliance with the procedure and their anxiety level associated with the procedure. METHODS: This study included 300 patients allocated to three groups (controls, and provision of written versus verbal information). Data were collected with identification form, perception form, State/Trait Anxiety Inventory, and the Visual Analogue Scale completed by the patients and the physician regarding patient compliance. Chi-square test, paired sample t-test and one-way ANOVA tests were used for statistical evaluation of the data, and Tukey's HSD test was used for further analysis. RESULTS: According to the results of the study, it was noted that the patients in the verbal information group responded more accurately to the questions related to the procedure. These patients experienced less pain, breathing difficulties and regret. Furthermore, they felt better during the procedure, were more satisfied, and evaluated the procedure as less difficult (p<0.05). The mean anxiety score of the patients in the verbal information group was significantly lower than of patients in the other groups (p<0.05). Compliance with the procedure was better in these patients than in the other groups, and the difference was statistically significant (p<0.05). CONCLUSIONS: In light of our findings, we suggest that providing verbal information to patients is recommended due to its positive effects on the patient's perception, compliance and anxiety level associated with the procedure.

Diagnostic accuracy of cascade stomach by upper gastrointestinal endoscopy in patients with obscure symptoms: a multi-center prospective trial.

AIM: Cascade stomach (CS) is a deformity of stomach, capable of leading dyspepsia, and its actual incidence is unknown. We investigated its frequency and performed a preliminary study to determine endoscopic diagnostic criteria. MATERIAL AND METHODS: One thousand four hundred and seventy-five consecutive patients were enrolled to this study. A criteria for CS in endoscopy was defined as follow: A fundal pouch after cardia, difficulty in passage from fundus to corpus and/or requiring a manoeuvre, an angulation separating fundus-corpus. Cases having all three criteria were considered as complete CS (CCS) only the third one as borderline CS (BCS). RESULTS: CS was diagnosed endoscopically in 33 (2.5%) and radiologically in 32 (2.4%) of patients with dyspepsia. Among endoscopically diagnosed CS patients, CCS was found to be present in 17 and BCS was found to be in 16 patients. Patients in whom CS was diagnosed endoscopically, radiological examination revealed CCS in 18 patients, BCS in 14 patients, and 1 patient with normal findings were detected. There were no significant differences between these two groups (P=0.559). CONCLUSION: CS can be presented with various upper abdominal symptoms, and it can easily be diagnosed when endoscopic criteria are considered.

Testing for hepatitis B and C virus infection before upper gastrointestinal endoscopy: justification for dedicated endoscope and room for hepatitis patients.

BACKGROUND/AIMS: Endoscopic interventions have become a significant tool in the diagnosis and treatment of gastrointestinal disorders. In order to avoid transmission of associated diseases, cleaning and disinfection/sterilization procedures of endoscopes and accessories are crucial. Hepatitis B virus and Hepatitis C virus infections are among the most common viral infections globally and maintain their position as a serious public health problem. METHODOLOGY: One thousand patients visiting our gastroenterology department were diagnosed and, except for cirrhosis, were enrolled in this study. For patients with HBsAg and Anti-HCV positive, Aspartate Aminotransferase, Alanine Aminotransferase, hemogram and prothrombin time were examined and ultrasonography was performed. RESULTS: Five hundred and seventy three patients (57.3%) were female and 427 patients (42.7%) were male. Among 1000 patients in total, 39 patients were detected to have hepatitis (3.9%). Of these patients, 28 (2.8%) had HBsAg (+), 10 (1%) had Anti-HCV (+), 1 (0.1%) had both HBsAg (+) and Anti-HCV (+). CONCLUSIONS: It would be beneficial to include a determination of hepatitis serology of patients prior to endoscopy in daily practice. In addition, like dialysis machines, there is a need for further studies evaluating the cost effectiveness of using separate endoscopy devices allocated to groups of patients with HBV, HCV or to those who do not carry hepatitis.

Non-Hodgkin lymphoma with high adenosine deaminase levels mimicking peritoneal tuberculosis: an unusual presentation.

Abdominal tuberculosis is still a medical problem in developing countries. The clinical presentation of tuberculous (TB) peritonitis may be similar to that of peritoneal carcinomatosis. Therefore, its diagnosis is rather difficult only with laboratory investigations. Ascitic fluid adenosine deaminase (ADA) activity has been proposed as a useful diagnostic test in tuberculous peritonitis, as many studies reported high ADA levels in TB peritonitis. On the other hand, ADA activity is usually lower in peritoneal carcinomatosis and malignant ascites. This study described a patient with non-Hodgkin lymphoma with elevated (67 U L(-1)) ADA levels and clinical signs mimicking peritoneal tuberculosis. On admission, this study focused on the high value of ADA in ascites and strongly suspected TP. Although anti-tuberculous agents were initiated, his general condition did not improve. Finally, laparoscopic peritoneal biopsy was performed and non-Hodgkin lymphoma diagnosed. In the light of these findings, ADA level may not reflect TB peritonitis in the absence of histopathological examination. Therefore, non-Hodgkin lymphoma should be kept in mind in the differential diagnosis in patients with high ascitic fluid ADA levels and in non-responders to anti-tuberculosis treatment.

Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis.

Hemorrhagic radiation proctosigmoiditis is a serious complication of pelvic radiation therapy. Pharmacotherapy is generally ineffective in the treatment of chronic radiation proctitis. Argon plasma coagulation is an effective, safe and well-tolerated therapy option for radiation proctitis. We report a case of hemorrhagic radiation proctosigmoiditis treated successfully with Argon plasma coagulation. We used argon plasma coagulation for mucosal coagulation in painting pattern set at 1.5 L/min and 60 W. After five therapy sessions with argon plasma coagulation, the patient's rectal bleeding and anemia resolved. After four months of argon plasma coagulation therapy, the patient is well and her endoscopic examination showed remarkable improvement of the vascular lesions. Blood transfusion requirement was resolved after therapy, and hemoglobin level increased from 8.2 g/dl to 11.5 g/dl. Argon plasma coagulation therapy may be useful as alternative treatment for hemorrhagic radiation proctitis. Future prospective controlled trials are necessary to confirm the efficacy of argon plasma coagulation in the treatment of radiation proctitis.