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BACKGROUND/AIMS: Gastroenterologists have an important role in the treatment and management of comorbidities related to obesity. Assessment of gastroenterologists' perception and attitude toward obesity was aimed in this study. MATERIALS AND METHODS: Survey questions were determined for the study. An online questionnaire was prepared afterward. Participants were invited via e-mail by providing them with information about the study. It was ensured that those who accepted the study could access the questionnaire form with the relevant link. Participants who answered all questions were included in the study. RESULTS: Totally 117 gastroenterologists were included in the study. The proportion of gastroenterologists who thought that obesity complicates the management of gastroenterological diseases and those who thought obesity as a factor that negatively affects the prognosis of gastroenterological diseases was determined as 88.9% and 95.7%, respectively. Among the obese patients, the proportion of those who applied diet therapy, exercise, pharmacotherapy, and endoscopic methods was 94%, 91.5%, 35%, and 37.6%, respectively. The rates of intragastric balloon therapy and intragastric botulinum toxin A injection were 30% and 21.4%, respectively. The proportion of those who agreed that obese patients lost a significant amount of weight with the treatment methods applied was 47.2%. The proportion of participants who agreed that long-term maintenance of weight loss was impossible for most obese patients was 59.8%. CONCLUSION: To our knowledge, this is the first study that evaluates the perception and attitude of gastroenterologists toward obesity. Our study results show that gastroenterologists think that obesity is a chronic disease and that gastroenterologists should be involved in management of obesity.
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Atitude do Pessoal de Saúde , Gastroenterologistas , Gastroenterologia , Obesidade , Humanos , Obesidade/psicologia , Obesidade/terapia , Turquia , Gastroenterologistas/psicologia , Gastroenterologistas/estatística & dados numéricos , Feminino , Masculino , Inquéritos e Questionários , Adulto , Pessoa de Meia-Idade , Gastroenterologia/estatística & dados numéricos , Percepção , Padrões de Prática Médica/estatística & dados numéricosRESUMO
Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease and is significantly associated with obesity, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular disease. NAFLD has become the most prevalent chronic liver disease in Western countries, and the proportion of NAFLD-related cirrhosis among patients on liver transplantation waiting lists has increased. In light of the accumulated data about NAFLD, and to provide a common approach with multi-disciplines dealing with the subject, it has become necessary to create new guidance for diagnosing and treating NAFLD. This guidance was prepared following an interdisciplinary study under the leadership of the Turkish Association for the Study of the Liver (TASL), Fatty Liver Special Interest Group. This new TASL Guidance is a practical application guide on NAFLD and was prepared to standardize the clinical approach to diagnosing and treating NAFLD patients. This guidance reflects many advances in the field of NAFLD. The proposals in this guidance are meant to aid decision-making in clinical practice. The guidance is primarily intended for gastroenterology, endocrinology, metabolism diseases, cardiology, internal medicine, pediatric specialists, and family medicine specialists.
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The combination of hepatitis B immunoglobulin and potent nucleos(t)ide analogs after liver transplantation is considered as the standard of care for prophylaxis against hepatitis B virus recurrence. However, the recommended doses, route of administration, and duration of HBIG administration remain unclear. Moreover, hepatitis B immunoglobulin-free prophylaxis with potent nucleos(t)ide analogs has shown promising disease outcomes in preventing hepatitis B virus recurrence. The current recommendations, produced by the Turkish Association for the Study of the Liver, Acute Liver Failure and Liver Transplantation Special Interest Group, suggest a reduced need for hepatitis B immunoglobulin administration with effective long-term suppression of hepatitis B virus replication using potent nucleos(t) ide analogs after liver transplantation.
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Antivirais , Hepatite B , Imunoglobulinas , Transplante de Fígado , Antivirais/uso terapêutico , Hepatite B/prevenção & controle , Humanos , Imunoglobulinas/administração & dosagem , RecidivaRESUMO
BACKGROUND/AIMS: Although living donor liver transplantation (LDLT) has been accepted as a primary treatment for adults with end-stage liver disease, concerns about donor health have been emerged. As LDLT is technically complex, it creates perioperative morbidity and mortality risk in donors. Biliary complications such as stricture and leakage are seen most frequently in donors after liver transplantation. While some of these complications get treated with conservative approach, endoscopic, surgical, and percutaneous interventions may be required in some others. We aimed to present endoscopic retrograde cholangiography (ERC) results in donors who developed biliary complications after LDLT. MATERIALS AND METHODS: Between June 2010 and January 2018, a total of 1521 donors (1291 right lobe grafts, 230 left lobe grafts) of patients who underwent LDLT, were retrospectively reviewed. 63 donors who underwent ERC due to biliary complication, were included in the study. RESULTS: Biliary stricture was found in 1.6% (25/1521), biliary leakage in 2.1% (33/1521), and stricture and leakage together in 0.3% (5/1521) donors. Our endoscopic success rates in patients with biliary leakage, biliary stricture, and stricture and leakage were 85% (28/33), 92% (23/25), and 80% (4/5), respectively. Surgical treatment was performed on 12.6% (8/63) donors who failed ERC. CONCLUSION: We found that ERC is a successful treatment for post-LDLT donors who have biliary complications.
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Doenças Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Hepatectomia/efeitos adversos , Complicações Pós-Operatórias , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Doenças Biliares/etiologia , Feminino , Humanos , Transplante de Fígado , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The original version of this article unfortunately contained a mistake in the author group section.
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Survival was examined from a Turkish liver transplant center of patients with HCC, to identify prognostic factors. Data from 215 patients who underwent predominantly live donor liver transplant for HCC at our institute over 12 years were included in the study and prospectively recorded. They were 152 patients within and 63 patients beyond Milan criteria. Patients beyond Milan criteria were divided into two groups according to presence or absence of tumor recurrence. Recurrence-associated factors were analyzed. These factors were then applied to the total cohort for survival analysis. We identified four factors, using multivariate analysis, that were significantly associated with tumor recurrence. These were maximum tumor diameter, degree of tumor differentiation, and serum AFP and GGT levels. A model that included all four of these factors was constructed, the 'Malatya criteria.' Using these Malatya criteria, we estimated DFS and cumulative survival, for patients within and beyond these criteria, and found statistically significant differences with improved survival in patients within Malatya criteria of 1, 5, and 10-year overall survival rates of 90.1%, 79.7%, and 72.8% respectively, which compared favorably with other extra-Milan extended criteria. Survival of our patients within the newly defined Malatya criteria compared favorably with other extra-Milan extended criteria and highlight the usefulness of serum AFP and GGT levels in decision-making.
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Carcinoma Hepatocelular/mortalidade , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/mortalidade , Doadores Vivos/provisão & distribuição , Recidiva Local de Neoplasia/mortalidade , alfa-Fetoproteínas/análise , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Taxa de SobrevidaRESUMO
OBJECTIVES: This study investigated the efficacy of ledipasvir-sofosbuvir, a newly developed direct-acting antiviral drug combination for hepatitis C virus infection recurrence in patients who have developed cirrhosis secondary to hepatitis C virus and who have undergone liver transplant. MATERIALS AND METHODS: We retrospectively analyzed 27 patients who underwent liver transplant due to hepatitis C virus-related cirrhosis and who received ledipasvir-sofosbuvirfor 12 weeks between January 1, 2016 and December 31, 2017 following transplant procedures conducted at the Inonu University Turgut Ozal Medical Center Gastroenterology Department between January 1, 2008 and December 31, 2017. None of the donors had hepatitis C virus infection. Most donor grafts used in transplants were from children of recipients, with the remaining donated grafts from husbands (7%), nephews (4%), wives (7%), and deceased donors (7%). RESULTS: Twenty patients were ultimately included in the study. Hepatitis C virus genotypes, hepatitis C virus RNA, blood counts, and liver enzyme levels of patients before and at 1, 2, and 6 months after treatment were evaluated. At the end of month 6, in addition to hepatitis C virus RNA levels of all patients decreased to unmeasurable levels, levels of alanine and aspartate aminotransferase and gamma-glutamyltransferase had also significantly decreased (all P < .001). None of the patients experienced a complication that led to cessation of treatment. CONCLUSIONS: With its reliability and high success rate, the ledipasvir-sofosbuvir combination is a strongly preferable treatment for patients who have undergone liver transplant due to chronic hepatitis C virus-related cirrhosis and who have virus recurrence posttransplant.
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BACKGROUND/AIMS: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population. MATERIAL AND METHODS: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed. RESULTS: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%). CONCLUSION: LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.
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Anilidas/administração & dosagem , Antivirais/administração & dosagem , Benzimidazóis/administração & dosagem , Ciclopropanos/administração & dosagem , Fluorenos/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Lactamas Macrocíclicas/administração & dosagem , Prolina/análogos & derivados , Ritonavir/administração & dosagem , Sofosbuvir/administração & dosagem , Sulfonamidas/administração & dosagem , Valina/administração & dosagem , Idoso , Quimioterapia Combinada , Feminino , Hepacivirus/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Prolina/administração & dosagem , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , TurquiaRESUMO
INTRODUCTION: Risk stratification based on biochemical variables is a useful tool for monitoring ursodeoxycholic acid (UDCA)-treated patients with primary biliary cholangitis (PBC). Several UDCA response criteria and scoring systems have been proposed for risk prediction in PBC, but these have not been validated in large external cohorts. METHODS: We performed a study on data of 1746 UDCA-treated patients with PBC from 25 centers in Europe, United States, and Canada. The prognostic performance of the risk scoring systems (GLOBE and UK-PBC) and the UDCA response criteria (Barcelona, Paris I, Paris II, Rotterdam, and Toronto) were evaluated. We regarded cirrhosis-related complications (ascites, variceal bleeding, and/or hepatic encephalopathy) as clinical end points. RESULTS: A total of 171 patients reached a clinical end point during a median 7 years (range 1-16 years) of follow-up. The 5-, 10- and 15-year adverse outcome-free survivals were 95%, 85%, and 77%. The GLOBE and UK-PBC scores predicted cirrhosis-related complications better than the UDCA response criteria. The hazard ratio (HR) for a 1 standard deviation increase was HR 5.05 (95% confidence interval (CI): 4.43-5.74, P < 0.001) for the GLOBE score and HR 3.39 (95% CI: 3.10-3.72, P < 0.001) for the UK-PBC score. Overall, the GLOBE and UK-PBC risk scores showed similar and excellent prognostic performance (C-statistic, 0.93; 95% CI: 0.91%-95% vs 0.94; 95% CI: 0.91%-0.96%). DISCUSSION: In our international, multicenter PBC cohort, the GLOBE and UK-PBC risk scoring systems were good predictors of future cirrhosis-related complications.
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Colagogos e Coleréticos/uso terapêutico , Progressão da Doença , Cirrose Hepática Biliar/diagnóstico , Cirrose Hepática Biliar/tratamento farmacológico , Ácido Ursodesoxicólico/uso terapêutico , Adulto , Fatores Etários , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Internacionalidade , Estimativa de Kaplan-Meier , Cirrose Hepática Biliar/mortalidade , Cirrose Hepática Biliar/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Resultado do TratamentoRESUMO
The aims of the present study were to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin in the treatment of chronic hepatitis C (CHC) in patients with advanced liver disease and to analyse whether the use of LDV/SOF treatment is associated with a new occurrence of hepatocellular carcinoma (HCC) during and after LDV/SOF treatment. The Turkish Early Access Program provided LDV/SOF treatment to a total of 200 eligible CHC patients with advanced liver disease. The median follow-up period was 22 months. All patients were Caucasian, 84% were infected with genotype 1b, and 24% had a liver transplantation before treatment. The sustained virological response (SVR12) was 86.0% with ITT analysis. SVR12 was similar among patients with Child-Pugh classes A, B and C disease and transplant recipients. From baseline to SVR12, serum ALT level and MELD score were significantly improved (P < 0.001). LDV/SOF treatment was generally well tolerated. Only one patient developed a new diagnosed HCC. Seventeen of the 35 patients, who had a history of previous HCC, developed HCC recurrence during the LDV/SOF treatment or by a median follow-up of 6 months after treatment. HCC recurrence was less commonly observed in patients who received curative treatment for HCC compared with those patients who received noncurative treatment (P = 0.007). In conclusion, LDV/SOF with or without ribavirin is an effective and tolerable treatment in CHC patients with advanced liver disease. Eradication is associated with improvements in liver function and a reduced risk of developing a new occurrence of HCC.
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Antivirais/uso terapêutico , Benzimidazóis/uso terapêutico , Carcinoma Hepatocelular/prevenção & controle , Fluorenos/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Neoplasias Hepáticas/prevenção & controle , Recidiva Local de Neoplasia/prevenção & controle , Uridina Monofosfato/análogos & derivados , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/virologia , Estudos de Coortes , Quimioterapia Combinada , Feminino , Genótipo , Hepacivirus/efeitos dos fármacos , Hepacivirus/genética , Humanos , Neoplasias Hepáticas/virologia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Ribavirina/uso terapêutico , Sofosbuvir , Resposta Viral Sustentada , Uridina Monofosfato/uso terapêuticoRESUMO
Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is an autosomal recessive disorder characterized by gastrointestinal dysmotility, cachexia, ptosis, peripheral neuropathy and leukoencephalopathy. The diagnosis is often not made until 5-10 years after the onset of symptoms. MNGIE is caused by mutations in thymidine phosphorylase gene TYMP. Here, we present a 19-year-old boy with MNGIE who had a chronic intestinal pseudo-obstruction, and we describe his family history. Genetic analysis revealed a novel homozygous c.765+1G>C intronic mutation which is expected to disrupt splicing of TYMP in the patient. Family screening revealed that the brother was also affected and the mother was a carrier. MNGIE should be considered and genetic testing instigated if individuals with cachexia have neuromuscular complaints or symptoms of chronic intestinal pseudo-obstruction.
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Pseudo-Obstrução Intestinal/complicações , Pseudo-Obstrução Intestinal/genética , Encefalomiopatias Mitocondriais/complicações , Encefalomiopatias Mitocondriais/genética , Mutação/genética , Sítios de Splice de RNA/genética , Sequência de Bases , Feminino , Humanos , Pseudo-Obstrução Intestinal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Encefalomiopatias Mitocondriais/diagnóstico por imagem , Distrofia Muscular Oculofaríngea , Oftalmoplegia/congênito , Linhagem , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
BACKGROUND/AIMS: Steroids have been shown to prevent intestinal oxidative stress. We investigated the effects of methylprednisolone on intestinal oxidative damage and bacterial translocation in thioacetamide-induced liver failure in rats. MATERIALS AND METHODS: Group 1 (n=8) was the control group. In group 2 (n=8), the thioacetamide group, rats received 300 mg/kg intraperitoneal thioacetamide daily for 2 days. In group 3 (n=8), the thioacetamide+methylprednisolone group, treatment with methylprednisolone (30 mg/kg intraperitoneal) was commenced 48 h before the first dose of thioacetamide. In group 4 (n=8), the methylprednisolone group, the rats received only methylprednisolone (30 mg/kg intraperitoneal). RESULTS: Serious hepatic and intestinal oxidative damage and high bacterial translocation frequencies were observed in the thioacetamide group compared with those of the controls. Bacterial translocation frequency in the thioacetamide+methylprednisolone group was significantly lower than that in the thioacetamide group (p<0.05). Intestinal thiobarbituric acid-reactive substances and myeloperoxidase levels and tissue damage scores for the intestines in the thioacetamide+methylprednisolone group were lower than those in the thioacetamide group (p<0.01, p<0.01, and p<0.0001, respectively). CONCLUSION: Our findings suggest that methylprednisolone reduces bacterial translocation by preventing intestinal oxidative damage in this model of acute liver failure in rats.
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Translocação Bacteriana/efeitos dos fármacos , Glucocorticoides/farmacologia , Falência Hepática Aguda/metabolismo , Falência Hepática Aguda/microbiologia , Metilprednisolona/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Glutationa/metabolismo , Íleo/metabolismo , Íleo/microbiologia , Íleo/patologia , Falência Hepática Aguda/induzido quimicamente , Falência Hepática Aguda/patologia , Masculino , Peroxidase/metabolismo , Ratos , Ratos Wistar , Tioacetamida , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismoRESUMO
BACKGROUND/AIMS: Living donor liver transplantations (LDLT) is a definitive treatment for patients with end-stage liver disease (ESLD), especially in the countries with donation problem. Between April 2007 and April 2010, we performed LDLT in 289 patients. Fifteen of the cases required re-transplantations. This study evaluates these 304 consecutive LDLTs donor and recipient outcomes. METHODOLOGY: Complication rates and survival data of the recipients and donors of 304 LDLT cases were analyzed. RESULTS: All donors are alive and well. Overall complication rate was 27%. Early postoperative recipient complication rate was 51%. Most frequent complication was infection. In the long-term there were 57 biliary stricture and 5 chronic bile fistula cases. Chronic and acute rejection attacks developed in 7 and 103 patients, respectively. Hepatic artery thrombosis rate was 8%. One, two and three year survival rates were 82%, 79% and 75%, respectively. Recipient mortality was 25%, mostly due to vascular complications, septic complications, liver dysfunction and chronic rejection. CONCLUSIONS: More than 150 liver tranplantations per year in a single center is a challenge in Turkey, where there is a shortage of deceased donor grafts. LDLT is a safe procedure for donors and effective for ESLD. Improvement in surgical technique would provide better outcomes.
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Transplante de Fígado , Doadores Vivos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Lactente , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Pessoa de Meia-IdadeRESUMO
Intestinal bacterial overgrowth (IBO) and increased mucosal permeability are suggested to increase bacterial translocation (BT) in liver injury. Rifaximin (RIF) is a minimally absorbed oral antimicrobial agent that restores gut microflora imbalance. The aim of the present study was to investigate the effects of RIF on BT frequency in thioacetamide (TAA)-induced liver injury. Group 1 was the control. In group 2 (TAA), rats received TAA daily for 3 days. In group 3 (TAA + RIF), RIF was commenced on the same day as the first dose of TAA. In group 4 (RIF), rats received only RIF. Ileal aspirate Escherichia coli counts were significantly lower in the TAA + RIF group than in TAA group. There was no difference in BT frequency between the TAA and TAA + RIF groups. Our results suggest that factors such as intestinal barrier dysfunction and impaired host immune shield, apart from IBO, play an important role in BT in this model.
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Translocação Bacteriana/efeitos dos fármacos , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/microbiologia , Escherichia coli/crescimento & desenvolvimento , Íleo/microbiologia , Rifamicinas/farmacologia , Tioacetamida/toxicidade , Animais , Carga Bacteriana , Doença Hepática Induzida por Substâncias e Drogas/patologia , Escherichia coli/isolamento & purificação , Íleo/efeitos dos fármacos , Fígado/microbiologia , Masculino , Ratos , Ratos Wistar , Rifamicinas/uso terapêutico , RifaximinaRESUMO
OBJECTIVE: The aim of the present case-control study was to determine whether or not the prevalence of gallbladder stones (GBS) was increased in patients with chronic myelocytic leukemia (CML) and to investigate clinical and laboratory characteristics of CML patients with GBS. SUBJECTS AND METHODS: This study included 56 patients with CML and 55 sex- and age-matched healthy controls. All participants underwent abdominal ultrasonography and the main clinical and laboratory characteristics were recorded. RESULTS: Gallbladder stones were detected in 13 (23.6%) patients with CML and in 3 (5.4%) control individuals (p < 0.05). The mean follow-up period of CML patients after diagnosis was 54.6 months, range 3-120 months. Hemoglobin levels were higher in the control group than in CML patients. However, total bilirubin, unconjugated bilirubin, lactate dehydrogenase levels, leukocyte and thrombocyte counts, frequency of splenomegaly and hepatomegaly were higher in the CML than in the control group (p < 0.05). Other clinical and laboratory values were not significantly different between the groups. CML patients with and without GBS were also compared for clinical and laboratory values. Age and follow-up period of CML patients after diagnosis were higher in the CML patients with GBS (p < 0.05). CONCLUSIONS: Higher prevalence of GBS in CML patients than in healthy controls was detected. We suggest that CML may increase the frequency of GBS, apart from other well-known risk factors. This risk is probably related to increased unconjugated bilirubin, which determines hemolysis, older age and long follow-up period of CML patients after diagnosis.
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Cálculos Biliares/complicações , Cálculos Biliares/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Casos e Controles , Feminino , Cálculos Biliares/sangue , Cálculos Biliares/diagnóstico por imagem , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Turquia/epidemiologia , UltrassonografiaRESUMO
BACKGROUND/AIMS: Acute pancreatitis is a serious complication of organophosphate poisoning. There is no report in the literature dealing with the development of a pancreatic pseudocyst after complication of organophosphate-induced acute pancreatitis. Therefore, we present a case who developed pancreatic pseudocyst after complication of organophosphate-induced acute pancreatitis. METHODS: A 17-year-old female patient with a history of ingestion of complication of organophosphate insecticide (DDVP EC 550, dichlorvos) was admitted with cholinergic symptoms. On admission, serum amylase and lipase levels were high and abdominal ultrasonography showed an edematous pancreas. No etiological factor for acute pancreatitis was evident. RESULTS: We diagnosed complication of organophosphate-induced acute pancreatitis. After four weeks, abdominal abdominal ultrasonography and computerized tomography revealed a pancreatic pseudocyst of 6 cm diameter. During follow-up, the pancreatic pseudocyst size regressed to 4 cm. CONCLUSION: Complication of organophosphate poisoning can cause acute pancreatitis and its complications. Early diagnosis and appropriate treatment may reduce morbidity and mortality.
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Organofosfatos/efeitos adversos , Pseudocisto Pancreático/induzido quimicamente , Pancreatite/induzido quimicamente , Doença Aguda , Adolescente , Feminino , Humanos , Tentativa de SuicídioRESUMO
We investigated the effect of caffeic acid phenethyl ester in rat ileum injury induced by chronic biliary obstruction. Swiss albino rats were divided into three groups: Group 1, sham (n = 7); Group 2, common bile duct ligation (n = 7); and Group 3, common bile duct ligation plus caffeic acid phenethyl ester (n = 7). In the caffeic acid phenethyl ester-treated rats, ileum tissue levels of malondialdehyde and myeloperoxidase were significantly lower than those of the bile duct-ligated rats (P < 0.001). The levels of tumor necrosis factor-alpha, interleukin-6, and interleukin-1alpha in the caffeic acid phenethyl ester group were significantly lower than those in the bile duct ligation group (P < 0.03, P < 0.01, and P < 0.02 respectively). The present study demonstrates that intraperitoneal administration of caffeic acid phenethyl ester in bile duct-ligated rats reduces intestinal oxidative stress. This effect may be useful in the preservation of intestinal damage in cholestasis.
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Translocação Bacteriana/efeitos dos fármacos , Ácidos Cafeicos/farmacologia , Colestase Extra-Hepática/patologia , Enterobacteriaceae/efeitos dos fármacos , Íleo/efeitos dos fármacos , Álcool Feniletílico/análogos & derivados , Staphylococcus aureus/efeitos dos fármacos , Animais , Colestase Extra-Hepática/microbiologia , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/fisiologia , Íleo/patologia , Fígado/microbiologia , Linfonodos/microbiologia , Masculino , Mesentério , Álcool Feniletílico/farmacologia , Ratos , Ratos Wistar , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/fisiologiaRESUMO
BACKGROUND/AIMS: Gingko biloba is an antioxidant substance which has antagonistic activity on platelet-activating factor. We aimed to investigate the antioxidant effect and the histopathologic changes caused by Gingko biloba on acetic acid-induced colitis. METHODS: Totally 22 rats were divided into three groups. Group 1 (n=7) served as the control group. Group 2 (n=7) and Group 3 (n=8) were given 2 ml/day of 4% acetic acid by intracolonic instillation for three days. Gingko biloba (100 mg/kg) was then given only to Group 3 intraperitoneally for three days. Oxidative stress was assessed by determinate tissue and serum malondialdehyde (MDA) levels, and colonic damage was assessed by histologic examination. RESULTS: Depth of necrosis, extent of necrosis, degree of inflammation, extent of inflammation, fibrosis and total histologic scores in Group 2 were significantly higher than in the control group (p<0.05). The same parameters were lower in Group 3 versus Group 2, but the difference was not significant. Tissue and serum MDA levels in Group 2 were significantly higher than Group 1 (p<0.01 and 0.05, respectively). Again, the same parameters in Group 3 were lower than in Group 2, but the difference was not significant statistically. CONCLUSIONS: Gingko biloba did not significantly affect histopathological and oxidative stress parameters in experimental colitis.
Assuntos
Ácido Acético/efeitos adversos , Colite/tratamento farmacológico , Ginkgo biloba , Fitoterapia , Animais , Antioxidantes/farmacologia , Biomarcadores/sangue , Colite/induzido quimicamente , Colite/patologia , Modelos Animais de Doenças , Fibrose/induzido quimicamente , Fibrose/prevenção & controle , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Masculino , Malondialdeído/sangue , Necrose/induzido quimicamente , Necrose/prevenção & controle , Estresse Oxidativo/efeitos dos fármacos , Extratos Vegetais/farmacologia , Fator de Ativação de Plaquetas/efeitos dos fármacos , Fator de Ativação de Plaquetas/metabolismo , Ratos , Ratos WistarRESUMO
Many studies have demonstrated that cirrhosis is frequently associated with autonomic dysfunction. The aim of this study was to test autonomic dysfunction in cirrhotic patients by analyzing heart rate variability (HRV), to determine whether or not the degree of autonomic dysfunction is correlated with the severity of disease, and, also, to compare the changes of HRV between survivor and nonsurvivor groups after 2-year follow-up periods. HRV was analyzed using 24-hr ECG recording in 30 cirrhotic patients and 28 normal controls. The changes in HRV parameters including mean normal-to-normal (N-N) interbeat intervals (mean NN), standard deviation of all N-N intervals (SDNN), standard deviation of the average of N-N intervals for each 5-min period over 24 hr (SDANN), root mean square succesive differences (r-MSSD; msec), and percentage of adjacent N-N intervals that are >50 msec apart (pNN50), all as time domain parameters, were evaluated. The cirrhotic patients were also evaluated according to Child-Pugh classification scores as markers of the disease severity. The time-domain measures of HRV in cirrhotic patients were significantly reduced compared with those in the control group (for all parameters; P < 0.001). The severity of disease was associated with reduced HRV measures (for all parameters; P < 0.001). After the 2-year follow-up periods, HRV measurements in cirrhotic patients were significantly much lower in nonsurvivors than in survivors (P < 0.001 for all). We conclude that increasing severity of cirrhosis is associated with a reduction in HRV. This finding may be an indicator of poor prognosis and mortality for cirrhosis.
Assuntos
Frequência Cardíaca/fisiologia , Cirrose Hepática/fisiopatologia , Análise de Variância , Estudos de Casos e Controles , Eletrocardiografia Ambulatorial , Feminino , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Análise de SobrevidaRESUMO
BACKGROUND/AIMS: Data suggests on the basis of thrice a week therapy, efficacy of mono consensus interferon is comparable to other alpha interferons. One-year follow-up after 12-month daily consensus interferon monotherapy for chronic hepatitis C among non-responders or relapsers to previous consensus interferon monotherapy is investigated. METHODS: Between February and August 1998, 11 non-cirrhotic patients with previous consensus interferon failure were treated. Six were relapsers and five non-responders. Serum HCV-RNA was tested at the 12th and 48th weeks of treatment and followed for one year thereafter. RESULTS: Eight (72%) were HCV-RNA negative at both 12th and 48th weeks. Of these, 60% (3/5) were among previous non-responders and 83% (5/6) were among previous relapsers. One year sustained virological response was 55%. Of this, 40% (2/5) were among non-responders and 66% (4/6) previous relapsers. CONCLUSIONS: These findings suggest that daily consensus interferon needs to be further investigated as an alternative to pegylated formulations, especially with the addition of ribavirin.