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OBJECTIVE To determine the relevance between the cut-off level of cancer antigen 125 (CA 125) level and long-term prognosis in high-grade serous ovarian cancer (HGSCs). STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Departments of Oncology, Medeniyet University Goztepe Education and Research Hospital, and Kartal Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey, from January 2017 to June 2019. METHODOLOGY Medical records of 230 women with HGSC were reviewed randomly from two Oncology Clinics. Descriptive analysis and CA 125 marker levels were evaluated with five years of disease-free survival rate (DFS) and overall survival rate (OS). Patients were divided into groups of high and low initial CA 125 levels (cut-off ≥385U/ml). The ability of initial serum CA 125 levels in predicting the presence of marker-recurrence of ovarian cancer were analysed using ROC (Receiver operating characteristics) curve analysis. RESULTS Statistically significant predictive value of initial CA 125 level was calculated as 385U/ml (p=0.008). The 5-year DFS of high and low CA 125 levels for all stages in HGSC was statistically significant (p

The morbidity and mortality associated with obesity have been known since the time of Hippocrates. Obesity has reached epidemic proportions worldwide and becomes a more serious medical, social, and economic problem recently. Lifestyle modification and pharmacotherapy have limited benefit. Bariatric surgery is an effective method of durable weight reduction with risks of life treating complications. Less invasive, safer and cheaper endoscopic therapies may be an alternative to surgery. The intragastric obesity balloon is a popular tool performed worldwide Intestinal obstruction due to migration of deflated balloon is a rare but life-threatening complication of this procedure.

Objective Stapedial acoustic reflex is an easily accessible and applicable test which is also valuable for the clinical conditions which affect the various locations of the central nervous system. Searching the diagnostic value of stapedial acoustic reflex at minimal hepatic encephalopathy is the aim of this research. Methods Diagnosis of minimal hepatic encephalopathy was conducted by mini-mental state and critical flickered frequency tests. Minimal hepatic encephalopathy diagnosed patients were established in the first group. Cirrhosis (without minimal hepatic encephalopathy or overt hepatic encephalopathy) diagnosed patients were created the control group. The stapedial acoustic reflex test was applied for minimal hepatic encephalopathy and the control group by audiologists in a soundproof room. Results In total, 221 patients were screened and 97 patients meet the inclusion criterions. Out of 97 patients, 52 were the minimal hepatic encephalopathy patients and the remaining patients were the control group. Acoustic reflex tests battery includes the evaluation of two pathways called ipsilateral and contralateral. Ipsilateral way test results were found positive in all minimal hepatic encephalopathy patients and 95% positive in the control group. Contralateral acoustic reflex test results were found 36% positive in minimal hepatic encephalopathy patients and 95% positive in the control group, respectively. A comparison of ipsilateral and contralateral acoustic reflex test results was displayed a statistical significance. Conclusion Stapedial acoustic reflex test results of cirrhosis patients may cover additional parameters for the diagnosis of minimal hepatic encephalopathy.

Background There are limited data about the mortality and morbidity of patients with HBV flare related to immunosuppressive treatments (IST) in the third-generation antivirals era. Herein, we performed a multi-centric study in patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) and evaluated their clinical course. Methods The study group included patients who were referred to gastroenterology or infectious disease specialists at eight different hospitals in Turkey. HBV flare was defined as at least a threefold elevation in alanine aminotransferase (ALT) levels above the upper limit of normal range. The demographic data, IST protocol, virological markers, liver tests, international normalized ratio (INR), HBV DNA, reactivation risk profile according to AGA guideline, MELD and MELD-Na scores were retrospectively evaluated. The primary aim of the study was to determine the liver-related mortality, including transplantation, at 12 weeks and factors predicting it. Secondary aims were to compare ETV and TDF with respect to mortality and time to ALT, bilirubin normalization and HBV DNA undetectability. Results The study group included 40 patients (29 males, mean age: 57 ±12 years). Twenty-five patients (62.5%) had a high risk of reactivation. Twenty-six patients received TDF and 14 patients received ETV treatment. Eight (20%) patients developed acute liver failure and one patient (2.5%) underwent living donor liver transplantation. Seven patients died due to liver-related complications, revealing a mortality rate of 17.5%. In multivariate analysis, total bilirubin levels at the onset, ALT levels and delta-MELD score at the first week were the independent risk factors for liver related mortality (HR: 1.222, 1.003, 1.253 and 95% CI: 1.096, 1.362; 1.001, 1.004 and 1.065, 1.470, respectively). There was no significant difference between the TDF and ETV groups with respect to time to normalize ALT and bilirubin levels, HBV DNA undetectability and mortality rates (16% and 21.4%, respectively). Conclusions HBV flare associated with IST has a high mortality in the third-generation antivirals era. High total bilirubin at the onset and high ALT and delta-MELD score at the first week predict poor prognosis.

Background The exocrine function of the pancreas is controlled by the autonomic nervous system (ANS), and autonomic neuropathy is a common and serious complication of diabetes. There are many factors contributing to the development of autonomic neuropathy in diabetic patients. Cardiovascular tests have been developed to evaluate the function of the ANS. This study investigated the relationship between cardiovascular autonomic neuropathy (CAN) and pancreas exocrine insufficiency (PEI) in diabetic patients. Methods This study evaluated 110 individuals with type 2 diabetes mellitus (T2DM) and 40 healthy volunteers. Autonomous neuropathy tests were utilized to diagnose patients, and Ewing and Clarke's criteria were employed to assess the severity of autonomous dysfunction. Stool samples were also collected from patients to measure fecal elastase-1 (FE-1). Results A 65.5% incidence of PEI was observed in DM patients. There was no significant correlation among the duration of disease, C-peptide, HbA1c, and PEI, respectively (P = .782, P = .521, P = .580). However, a significant difference between DM patients and controls in terms of cardiac dysautonomia (P = .001) was seen. Moreover, a statistically significant correlation between the degree of cardiac dysautonomia and FE-1 level was observed within the patient group (P =.001). Conclusion It is possible that the disruption of exocrine hormone secretion in the pancreas due to the impairment of enteropancreatic reflexes is secondary to diabetic autonomic neuropathy and resulting in PEI. This study also showed that autonomic neuropathy might develop and cause PEI in diabetic patients without known added confounding factors.

Amaç – Bu araştırmada, tüketicilerin, işletmeler tarafından uygulanan çeşitli fiyatlandırma politikalarına yönelik düşüncelerinin ortaya çıkarılması amaçlanmıştır. Bu doğrultuda, etik dışı fiyatlandırma yöntemlerinden raf ve kasa fiyatı uyumsuzluğu, fahiş fiyatlandırma, indirimli fiyatlandırma, fiyat reklamları, küsuratlı fiyatlandırma ve fiyat farklılaştırma uygulamaları incelenmiştir. Yöntem – Bu araştırmada nitel ve nicel yöntem bir arada kullanılmıştır. Nitel bağlamda, ilgili etik dışı fiyatlandırma uygulamalarını kapsayacak şekilde 6 adet senaryo oluşturulmuş; cevaplayıcıların bu senaryolara ilişkin düşünceleri elde edilmeye çalışılmış ve elde edilen düşüncelerin analizinde kodlama yönteminden faydalanılmıştır. Nicel bağlamda, veri toplama aracı olarak anketten faydalanıldığı gibi tüketici hakları bilincini ölçmeye yönelik sorulardan da yararlanılmıştır. Anket formu, Mayıs 2019’da uygulanmış; toplanan 548 anketten 529 tanesi analize uygun bulunmuştur. Bulgular – Elde edilen bulgular incelendiğinde, tüketicilerin ilgili fiyatlandırma yaklaşımlarını etik dışı bulduğu, aldatıcı/kandırıcı nitelik taşıdığı, işletmelere karşı olumsuz tutum beslemelerine ve bağlılıklarının azalmasına neden olduğu görülmektedir. Tüketiciler etik dışı fiyatlandırma uygulamalarına maruz kaldıklarında, tepki gösterme ve şikayet etme eğiliminde oldukları görülmekle birlikte, bunu daha çok geleneksel yöntemlerle çözme arayışına gitmektedir. Şikayet etme noktasında, hukuki kanalların ne olduğunu ve bu kanalların nasıl kullanılacağına ilişkin tüketici bilinci ise oldukça düşük çıkmıştır. Tartışma – Tüketiciler, etik dışı fiyatlandırma yaklaşımları karşısında genel anlamda kandırıldıklarını ve aldatıldıklarını düşünmektedirler. Ortaya çıkan bu olumsuz algılar ise firmalara karşı olumsuz tutum beslemeye, günümüz rekabetçi piyasa koşullarında bir hayli önemli olan müşterilerin elde tutulmasını gözden kaçırmaya ve potansiyel müşterilere ise hiç ulaşamamaya neden olmaktadır.

The main objective is to define the mortality of patients with cancer admitted to our hospital, their clinical and demographic characteristics, investigate the risk of COVID-19 for patients with cancer, and determine factors that affect the mortality rates of patients with cancer dying of COVID-19. A total of 2401 patients were admitted to our hospital with the diagnosis of COVID-19 from March 11th, 2020, to May 31st, 2020. Ninety-two out of a total of 112 cancer patients were included in this study based on the planned inclusion/exclusion criteria. The clinical, demographic, and laboratory features and treatments provided were studied, and their effect on mortality rates was analyzed. In our study the median age of the patients was 67 years, and 55.4% were male. More than half (56.5%) of our patients had metastasis. The mortality rate was 6.2% in the overall population with COVID-19, whereas it was 23.9% in patients with cancer. The mortality rate in patients with metastasis was statistically significantly higher compared with those without metastasis (34.0% vs. 10.3% P = 0.008). The mortality rate in patients still smoking was statistically significantly higher than in non-smokers (37.5% vs. 12.5% P = 0.033). The mortality rates of patients with high average C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer levels were statistically significantly higher than in those without, and the mortality rates of patients with lower average albumin and hemoglobin levels were statistically significantly higher than those without (P < 0.001, P = 0.006, P = 0.041, P < 0.001, P < 0.001, and P = 0.028, respectively). Having metastases concurrent with COVID-19 was a statistically significant factor predictive of prognosis. Also, high CRP, ferritin, LDH, and D-dimer, and low albumin and hemoglobin were related to increased mortality rates. The predictive and prognostic role of possible factors related to prognosis is still unknown and further large, multicenter prospective studies are needed to confirm these results.

Purpose We aimed to determine the COVID-19 infection rate and determine the factors that affect hospitalization and prognosis in patients receiving systemic chemotherapy (CT), immunotherapy (IT) and molecular-targeted therapies at our hospital within three months after the onset of COVID-19 pandemic. Materials and methods The patients who received systemic treatment at chemotherapy unit with diagnosis of cancer between 11 March 2020 and 11 June 2020 were included. The clinical and demographic characteristics of patients, the systemic treatments that they received (CT, IT, targeted therapies), and the stage of disease were determined. For the parameters that affect the hospitalization of COVID-19 infected patients were also determined. Results Among 1149 patients with cancer, 84 of them were infected with COVID-19, and the median age of infected patients was 61.0 (IQR: 21–84) and 60.7% of them were male. As a subtype of cancers lung cancer was more frequent in the patients who infected with COVID compared with non-infected ones and the difference was statistically significant when the underlying malignities were compared (32.1% vs 19.0%, p = 0.031). The hospitalization rate and receiving COVID-19 treatment were more frequent in metastatic patients who were receiving palliative therapy, and the difference was statistically significant ( p = 0.01, p = 0.03). In our study, infection rate was similar among patients treated with CT, IT and CT plus targeted therapy; however, fewer COVID-19 infections were seen at patients who received only targeted therapy. Conclusion COVID-19 infection is more frequent in cancer patients and tends to be more severe in metastatic cancer patients receiving anticancer treatment, and the continuation of palliative cancer treatments in these patients may cause increased cancer and infection-related morbidity and mortality.

Objectives: Ovarian cancer is associated with the highest mortality of gynecologic cancers. Epidemiological and genetic factors of ovarian cancer development are clearly defined but prognostic factors have not been adequately identified. Right and left ovarian cancers seem to act different behaviors at high-grade serous ovarian cancer (HGSOC) prognosis. The aim of this study is to explain this prognostic role of its sidedness. The aim of this study is to explain this prognostic role of its sidedness. Material and methods: We reviewed 160 consecutive patients with Figo stage 1-3 HGSOCs and undergone surgery at two high-volume hospitals. Prognostic effects of primary tumor location onset were evaluated in terms of 5-year disease free survival and overall survival rate. Results: One hundred-sixty patients with ovarian cancer records were analyzed using the Kaplan-Meier method, that demonstrated a significant difference in the 5-year disease-free survival rates between right and left-sided cancers for all stages (44.6% vs 78.5%, p < 0.001). Also, there was significant difference in the 5-year overall survival rates between the two groups (71.1% vs 91.9%, p = 0.020). Conclusions: Tumor location within the HGSOC seems to be a compelling prognostic factor ovarian cancer. Further prospective studies are needed in order to support our hypothesis.

Background Ado-trastuzumab emtansine is an antibody-drug conjugate that combines the cytotoxic activity of emtansine with human epidermal growth factor receptor 2-targeted antitumor features of trastuzumab. Objective We conducted a study of metastatic breast cancer patients treated with trastuzumab emtansine. By evaluating progression-free survival, overall survival, and response rates, we aimed to find prognostic factors of trastuzumab emtansine treatment. Methods Our study is a single-center, retrospective, observational study. We have clinical data from 78 patients treated with trastuzumab emtansine for metastatic breast cancer, from May 2016 through May 2019, at Kartal Dr Lutfi Kirdar Education and Research Hospital, Medical Oncology Department. Our objective is to assess the survival and response rates in trastuzumab emtansine-treated individuals and the factors associated with survival. The factors we analyzed were cancer antigen 15-3 sensitivity, Eastern Cooperative Oncology Group-Performance Status, presence or absence of visceral metastases, presence or absence of cranial metastases, and treatment-associated thrombocytopenia. Results Among 78 patients, median progression-free survival was 7.8 months, and overall survival was 21.1 months. Twenty of the patients had an objective tumor response. The results showed that trastuzumab emtansine was tolerable with a manageable safety profile and consistent with the results of the previous literature. Mostly seen adverse events were anemia, thrombocytopenia, fatigue, and increased levels of alkaline phosphatase. Patients with Eastern Cooperative Oncology Group-Performance Status = 2 had worse progression-free survival and overall survival compared to ones with Eastern Cooperative Oncology Group-Performance Status Conclusions Trastuzumab emtansine prolongs progression-free survival and overall survival with a manageable safety profile. Thrombocytopenia, Eastern Cooperative Oncology Group-Performance Status, and cancer antigen 15-3 are correlated with progression-free survival and/or overall survival.

The main purposes of this research are (1) to reveal the virtual credit card (VCC) awareness of online shoppers and (2) to prepare a to do list for managers and relevant institutions to provide a more secured internet shopping process by enhancing the trust perception of consumers. To this end, a structured questionnaire consists of three sections was designed and conducted during the period April-May 2018 in Turkey. The findings achieved show that online shoppers mostly attach importance to the recognition of the website, which means they seek trust in online shopping process. On the other hand, they mostly use credit and debit cards, which may make consumers encounter serious fraud issues. VCC usage is only 4.9% in general although VCC awareness is 55.1%. This low level of VCC awareness is associated with education level and the information provided by the financial banks.

Introduction/Background General survival (GS) and clinical characteristics of the patients (NACT) undergoing interval debulking after neoadjuvant chemotherapy and the patients undergoing adjuvant chemotherapy after primary debulking surgery (PDS) were compared retrospectively among the patients with FIGO stage 3 and 4 ovarian carcinoma. Methodology In this study, 141 patients who were diagnosed with FIGO stage 3 or 4 epithelial ovarian or fallopian tube carcinoma between 2009 and 2017 and had completed file data were included. Results 73 (51.8%) patients and 68 (48.2%) patients were included in the in the NACT and PDS groups, respectively. 56 patients (81.2%) in the NACT group and 67 patients (98.5%) in the PDS group had an ECOG 0–1 performance score (p= 0.001). Average age was 60.4 ± 10 and 52.2 ± 10 years in the NACT and PDS groups, respectively (p Conclusion NACT group in this study, these patients were older, they had lower ECOG performance scores, and their CA 125 levels were higher. Unlike the randomized trials, this study is important in order to show the characteristics of the patient group sent to neoadjuvant therapy in ovarian cancer as well as the GS results in real life clinical practices. Disclosure Nothing to disclose

Purpose The aim of this study was to evaluate the efficacy of abiraterone in patients with castration-resistant metastatic prostate cancer. Materials and methods We retrospectively analyzed 51 patients with mCRPC treated with abiraterone acetate from January 2014 to August 2018. Clinicopathological information, treatment modalities, treatment responses, and survival times were retrospectively reviewed. Results A total of 51 patients who received abiraterone 1000 mg/day + prednisone 10 mg/day between January 2014 and August 2018 were included in the study. Of these patients, 33 (64.7%) had post-chemotherapy (CT) and 18 (35.3%) had CT-naive abiraterone receipt. Median overall survival (OS) was 17.3 months (range 9.3-33.1). Median OS was found to be 12.7 months (range 9.4-18.3) and 29.4 months (range 9.3-33.0) in the CT-naive and post-CT group, respectively (P = .236). Median radiographic PFS (rPFS) was 10.1 months (range 4.5-18.4). In the CT-naive group, rPFS was 10.1 months (IQR 6.0-14.7) and in the post-CT group, it was 9.7 months (range 4.0-18.4) (P = .808). PSA progression-free survival (PSA-PFS) was 9.1 months (range 4.6-13.1). In the CT-naive group, PSA-PFS was 7.4 months (range 4.6-13.4) and in post-CT, it was 9.1 months (range 4.8-13.1) (P = .843). Conclusions These results show that abiraterone acetate is an effective and reliable agent in real-life data.

BACKGROUND/AIMS: The primary aim of this study is to identify whether an autoimmune sensorineural hearing loss is an extraintestinal neurological manifestation in adult CD patients. The secondary aim is to identify whether the duration of a gluten-free diet has an effect on the hearing levels of CD patients. MATERIALS AND METHODS: This prospective study consisting of 103 adult CD patients and 79 healthy controls between May 2012 and August 2018 at the University of Gaziantep Gastroenterology and Otorhinolaryngology Departments. CD patients were divided into two groups as remission or active, according to their gluten-free diet duration and serum levels of anti-t-TG. The control group was checked both for CD symptoms and anti-t-TG serum levels. Both participants performed a pure tone audiometry after detailed ear nose and throat examination. RESULTS: Only 4 of 103 CD patients showed sensorineural hearing loss. There was no statistically significant difference between hearing levels of the CD patients and the control group in both measurements of air and bone conductions. The hearing levels comparing the remission and active CD patients did not show any difference in air and bone conduction frequencies. CONCLUSION: In this study with a higher number of CD patients when compared with the previous studies, it has been shown that CD does not appear to cause autoimmune sensorineural hearing loss. In addition, the status of the patients regarding the activeness or the remission of CD did not display a differ between the CD patients in terms of hearing levels.

Anastomoz darlıkları kolorektal cerrahinin bilinen bir komplikasyonu olmasına rağmen benign hastalıklarda komplet kolonik anastomoz obstrüksiyonu nadirdir. Benign darlıklar low-anterior rezeksiyon sonrası yapılan kolorektal anastomozda nispeten sık görülen bir komplikasyondur ve kolorektal anastomozların %5-22’sinde gelişebilir. Günümüzde benign anastomoz darlıklarının tedavisinde ilk seçenek endoskopik girişimlerdir. Çeşitli endoskopik teknikler tarif edilmesine rağmen optimal yaklaşım için kontrollü prospektif çalışma verileri eksiktir. Bu çalışmada ileri derecede anastomoz darlığı gelişmiş ve endoskopik balon dilatasyon uygulanan bir hastanın sunulması amaçlandı. Hastaya bir haftalık rektal mesalazin tedavisinden sonra bir kez ayaktan balon dilatasyonu uygulandı ve darlık giderildi. Rektal mesalazin uygulamasının darlık bölgesindeki inflamutuvar sürece olumlu etkisi oldu ve balon dilatasyon sayısını azalttı. Kolorektal darlıkların tedavisinde endoskopik balon dilatasyon 1985’ten beri kullanılmaktadır. Minimal invaziv bir yöntemdir, başarı oranı yüksektir, güvenle direkt görüş altında yapılabilir, tekrarlanabilir ve hastanede yatış gerektirmez., Although anastomotic strictures are a recognized complication of colorectal surgery, complete colonic anastomotic obstruction from benign disease is rare. A benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection and may develop colonic anastomosis in 5%-22% of cases. Today, endoscopic interventions have become the preferred first-line treatment for postoperative large bowel strictures. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials regarding the optimal approach. In this study, a case of severe anastomotic stricture of the colon, during which endoscopic balloon dilatation was performed, is presented. After a one-week course of treatment with rectal mesalazine, the ambulatory patient underwent balloon dilation only once and the stricture resolved. Rectal mesalazine administration had a positive effect on the inflammatory process at the site of stenosis and reduced the number of balloon dilatations. Endoscopic balloon dilatation has been used since 1985 for the treatment of colorectal strictures. It is a minimally invasive method, has a high success rate, can be performed safely under visual control, can be performed repeatedly, and does not require hospitalization.

Objectives: To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP). Methods: In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded. Results: Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A. Conclusion: Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination. Saudi Med J 2016; Vol. 37 (11): 1191-1195 doi: 10.15537/smj.2016.11.14557 How to cite this article: Kilic E, Demiriz B, Isikay N, Yildirim AE, Can S, Basmaci C. Alfentanil versus ketamine combined with propofol for sedation during upper gastrointestinal system endoscopy in morbidly obese patients. Saudi Med J . 2016 Nov;37(11):1191-1195. doi: 10.15537/smj. 2016 .11.14557.

Delirium is a complex neuropsychiatric syndrome that typically involves a plethora of cognitive and non-cognitive symptoms, resulting in a broad spectrum of differential diagnosis dominated by mental disorders. The prevalence of delirium in elderly patients admitting to hospital is 5-55% [1]. Delirium is a common neuropsychiatric syndrome that may occur in several different settings and one of them is vitamin B12 deficiency. Vitamin B12 deficiency causes many cerebral cortex abnormalities such as confusion, mood and memory changes, delirium with or without hallucinations, depression and acute psychotic states [2,3]. Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction after exclusion of unrelated neurologic and/or metabolic abnormalities. The clinical manifestations of HE is characterized by cognitive and motor deficits of varying severity without specific lesions in the central nervous system. The symptoms range from minimal changes in personality to coma, including delirium [4]. Usually, in the elderly patients with cirrhosis, it is hard to differentiate two clinical situations. Here we report a case of an elderly patient with cirrhosis who experienced delirium due to vitamin B12 deficiency, but was treated as HE before.

Analgesics, including opioids such as meperidine are used for treatment of abdominal pain caused by acute pancreatitis. Meperidine withdrawal syndrome is usually seen after long-term use. We present here an acute panceratitis patient who experienced meperidine withdrawal syndrome after short term use and treated successfully with tramadol and deksketoprofen.

The purpose of this study was to evaluate the technical/hemodynamic success, complications, and biochemical/ hematologic consequences of transjugular intrahepatic portosystemic shunt (TIPS) created with 10-mm bare stents in our patients.Data of 27 cirrhotic patients (18 men and 9 women; mean age, 39.7±18.7 years) with a median MELD score 14 (range 7-31) treated with TIPS between January 2000 and August 2010 were evaluated retrospectively.The indications were refractory bleeding varices in 48.2%, refractory ascites in 22.2%, and Budd-Chiari syndrome in 29.6% of the patients. Technical and hemodynamic success rates were 96.3% and 92.3%, respectively. Mean portosystemic pressure gradient decreased from 21.5±5.3 mm Hg to 9±2.7 mm Hg (p0.05). The rate of primary stent patency was 76.9% 1 year after the procedure. No statistically significant difference in shunt dysfunction was found between the groups of patients treated for Budd-Chiari syndrome and other indications (p0.05). One patient (3.7%) had shunt dysfunction due to thrombosis within 24 hours. New and/or worsening hepatic encephalopathy occurred in 34.6% of patients. Increased age (≥40 years) was significantly related to hepatic encephalopathy in both univariate and multivariate analyses (p0.05). Thirty-day mortality rate and 1-year transplant-free survival rate were 0% and 80.7%, respectively.Transjugular intrahepatic portosystemic shunt procedure is a safe treatment for many patients with cirrhosis, but post-procedure hepatic encephalopathy and shunt dysfunction are still problems. Especially, patient age should be taken into consideration in predicting hepatic encephalopathy risk.

Adenosine deaminase (ADA) is found in most tissues including the pancreas. Its role in inflammation and malignancy has been studied experimentally. To date, serum ADA levels in pancreatic diseases have not been studied before.To assess the levels of ADA in patients with pancreatitis and cancer of the pancreas.Serum levels of ADA were investigated in 14 cases with acute pancreatitis (mean age 46 years; male/female 5/9), 38 with chronic pancreatitis (mean age 46 years; male/female 25/13), 21 with cancer of the pancreas (mean age 67 years; male/female 11/10), and 21 healthy controls (mean age 40 years; male/female 11/10). The ADA levels were also compared among patients with pancreatic cancer with regard to tumor size and localization and the presence of metastases. Correlation analysis between ADA and CA 19.9 was also performed.Serum ADA levels were 12.66 (9.54-20.72), 12.51 (8.88-26.64), 15.36 (10.20-21.05) and 9.39 (6.58-11.84) U/l in patients with acute pancreatitis, chronic pancreatitis, pancreatic cancer, and healthy controls, respectively. Serum ADA levels were significantly higher in acute and chronic pancreatitis, and pancreatic cancer patients compared to the control group (p0.05). Pancreatic cancer patients had significantly higher serum ADA levels when compared with acute and chronic pancreatitis cases (p0.05). The serum ADA levels were comparable according to tumor size and location and the presence of metastases. There was a linear correlation between serum ADA and CA 19-9 levels (p = 0.027, r = 0.552).Our data suggest that the ADA enzyme may play a role in inflammatory diseases of the pancreas. Serum ADA levels increase in pancreatic disorders especially in pancreatic cancer. It may be a serum marker for the diagnosis of pancreatic cancer.

Vasoconstrictor therapy with terlipressin and concomitant albumin can improve renal function in patients with hepatorenal syndrome (HRS) type 1, but the efficacy of therapy in patients with active infection is controversial. The aim of this study was to investigate the efficacy, adverse effects, and predictors of terlipressin therapy and to find out whether there was a difference in response rates between the patients with or without active infections. Data of 58 patients with type 1 HRS treated with terlipressin and albumin were retrospectively evaluated. Twenty-six patients (44.8 %) showed complete response to treatment. Response rates of patients with or without active bacterial infection were 47 and 43.9 %, respectively (p > 0.05). Only baseline serum creatinine level was significantly related to response in univariate/ multivariate analyses (p < 0.05). Twenty-three patients (39.6 %) developed adverse effects probably related to treatment. In 8.6 % of patients, treatment was discontinued because of adverse effects of therapy. Four patients (6.9 %) developed ischemic adverse events, including nonfatal myocardial infarction, intestinal ischemia, and cutaneous necrosis. Terlipressin plus albumin therapy improved renal function in nearly half of patients with type 1 HRS. Thus, it seems a reasonable treatment for patients with active bacterial infections. Baseline serum creatinine level is a potential predictor of terlipressin response.