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In this case report, we present a case of autoimmune pancreatitis (AIP) diagnosis in a patient after a 7-year history of suspicious pancreatic cancer. Kim's and Japanese criteria were used to diagnose AIP. Our case avoided undesirable invasive procedures and recovered thanks to the proper diagnosis and timely treatment with prednisone. Early and accurate diagnosis of AIP, in this case, had a significant impact on the treatment and prognosis process. (C) 2021 The Author(s) Published by S. Karger AG, Basel

Aim The aim of this study was to evaluate nutritional status and sarcopenia in patients with inflammatory bowel disease (IBD) in clinical remission. Methods A total of 344 patients with IBD in clinical remission were included in this cross-sectional study. Patients with clinical activity (Harvey-Bradshaw index >5 for Crohn's disease and partial Mayo scores ≥5 for ulcerative colitis) were excluded. Sociodemographic, clinical, and anthropometric data were recorded. BMI was categorized according to WHO criteria. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire. Body composition included fat-free mass (FFM) analyzed with Tanita-330 ST. Muscle strength was measured with a Takei digital hand grip dynamometer using a standard protocol. Physical performance was measured as 4-m gait speed. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People 2 criteria. Results Overall, 5.5% of patients were underweight, 9.9% were malnourished, and 39.5% were at risk of malnutrition. Sarcopenia and probable sarcopenia were diagnosed in 41.3% of patients. Total number of flares requiring hospitalization (100%) was the most important predictor of sarcopenia, followed by total number of flares (80.1%), FFMI (46.5%), age (44.6%), BMI (31.8%), MNA score (27.7%), serum creatinine (23.6%), anti-tumor necrosis factor alpha use (23.3%), and gender (17.8%). Conclusion In conclusion, our findings revealed a considerable proportion of IBD patients in clinical remission to be malnourished or at risk of malnutrition along with a high rate of sarcopenia. This emphasizes the need for concomitant screening for nutritional status and body composition analysis in patients with IBD for provision of appropriate nutritional support, even during the remission period, and prevention of sarcopenia-related surgical and poor clinical outcomes.

INTRODUCTION: Ectopic pancreas is defined as pancreatic tissue located outside the normal pancreas. The aim of the present study was to determine the sonographic characteristics of lesions considered as ectopic pancreas via endoscopic ultrasonography examination.METHODS: This retrospective single-center study included 53 patients diagnosed with ectopic pancreas by endoscopic ultrasonography between March 2014 and March 2020.RESULTS: In the study, 32 (60.4%) patients were female and mean age was 44.7 ± 12.1 years. Further, 37 (69.8%) lesions were detected at the antrum greater curvature side, 10 (18.9%) at the antrum posterior wall, three (5.7%) at the corpus, two (3.8%) at the bulbus. EUS examination revealed that all lesions exhibited a heterogeneous pattern, 52 (98.1%) lesions had a hypoechoic appearance, 45 (85%) lesion borders were regular, and 45 (85%) showed central umbilication. The lesions were most frequently located in the submucosa (90.6%). The mean long axis was 10.7 ± 3.5 mm, mean short axis was 4.8 ± 1.0 mm, and long/short axis ratio was 2.4 ± 0.9. No significant difference was observed between the dimensions and size ratios of lesions and the presence or absence of umbilication (p = 0.550; 1.000 and 0.583, respectively).DISCUSSION AND CONCLUSION: In cases where the endoscopic ultrasonography examination revealed subepithelial lesions of submucosal origin that are 1.5 along with central umbilication, the diagnosis of ectopic pancreas should be prioritized., GİRİŞ ve AMAÇ: Ektopik pankreas, normal pankreas dışında kalan pankreas dokusudur. Bu çalışmanın amacı, endoskopik ultrason incelemesi ile ektopik penakreas olduğu düşünülen lezyonların sonografik özelliklerinin belirlenmesidir.YÖNTEM ve GEREÇLER: Çalışmamız Mart 2014–Mart 2020 tarihleri arasında endoskopik ultrason incelemesi ile ektopik pankreas tanısı konulan 53 olgunun retrospektif tek merkezli değerlendirilmesini içermektedir.BULGULAR: Çalışmamızdaki olguların 32 (%60,4)’si kadın ve yaş ortalaması 44,7 ± 12,1 yıl saptanmıştır. Lezyonların 37 (%69,8)’si antrum büyük kurvaturda, 10 (%18,9)’u antrum posterior, üçü (%5,7) korpus, ikisi (%3,8)’bulbusta saptanmıştır. Endoskopik ultrason incelemesinde, lezyonların tamamı heterojen paternde, 52 (%98,1)’si hipoekoik görünümde, 45 (%85)’inin sınırları düzenli olduğu ve 45 (%85)’inde de santral umbilikasyon varlığı saptanmıştır. Lezyonların en sık (%90,6) submukoza yerleşimli olduğu görülmüştür. Lezyonların uzun aks ortalaması 10,7 ± 3,5 mm, kısa aks ortalaması 4,8 ± 1 mm ve uzun aks / kısa aks oranı 2,4 ± 0,9 olarak saptanmıştır. Umbilikasyon varlığı ile lezyonların boyutları ve boyut oranları arasında anlamlı farklılık saptanmamıştır (sırasıyla p = 0,550; 1,00 ve 0,583).TARTIŞMA ve SONUÇ: Endoskopik ultrason incelemede; 2cm’den küçük, submukozal orijinli, heterojen ve hipoekoik paternli, anekoik kanal benzeri yapıların olduğu, santral umbilikasyonun eşlik ettiği, uzun aks / kısa aks oranı 1,5’den büyük olan subepitelyal lezyonların saptanması durumunda ektopik pankreas teşhisi ön planda tutulmalıdır.

Amaç: Bu çalışmada mide kanserinin (MK) epidemiyolojik ve genel sağkalım (GSK) özelliklerinin araştırılması amaçlanmıştır. Gereç Yöntem: Ege Üniversitesi Kanserle Savaş Uygulama ve Araştırma Merkezine (EÜKAM) 1992- 2017 yıllarında kayıtlı Ege Üniversitesi Tıp Fakültesi Hastanesi kanser verileri retrospektif olarak taranmıştır. CAN-REG-4 bilgisayar programına kayıtlı veriler, Dünya Sağlık Örgütü ve Surveillance, Epidemiology, and End Results sistemlerinde gruplanarak analizler yapılmıştır. İstatistik analizlerde ki- kare, General Linear Model (GLM), Kaplan Meier sağkalım analizleri uygulanmıştır. Etik kurul onayı alınmıştır. Bulgular: EÜKAM veri tabanına kayıtlı toplam 117.139 kanserden 4.212’si (%3,6) MK’dir. Gastrointestinal sistem kanserler içinde kolorektal kanserlerden sonra ikinci sıklıkta MK (%21,6) yer almıştır. Olguların 2.692’si (%63,9) erkek, 1.520’si (%36,1) kadındır, arasındaki fark istatistiksel olarak anlamlıdır (p

Momordica charantia L., known as bitter melon (BM), is a plant that belongs to the family Cucurbitaceae. Aims of this study are to investigate the anti-inflammatory effect of crude BM extract on 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced experimental colitis model in rat. It was also aimed to determine the content and bioaccessibility of carotenoids of BM. BM was purchased from local markets in Izmir, Turkey. Fruits of BM were lyophilized, powdered, and used in the experiment. Carotenoids were determined by high-performance liquid chromatography. To determine the bioaccessibility of beta-carotene, in vitro digestion was performed. Wistar albino rats were divided into four groups: group A (BM+TNBS), group B (BM), group C (TNBS), and group D (control). BM solution was given 300 mg/(kg center dot day) for 6 weeks orally. Colitis was induced by 0.25 mL of a solution containing 100 mg/kg 5% (w/v) TNBS in 50% ethanol (w/v) intrarectally after 6 weeks. After sacrification, macroscopic and microscopic evaluations were performed. Myeloperoxidase, cytokines levels (interleukin-17 [IL-17], TNF-alpha, and interleukin-10 [IL-10]) were measured in serum and colonic samples by ELISA test. Institutional Animal Ethics Committee approval was obtained. Total carotenoid content of BM was determined 11.7 mg/g dry weight as beta-carotene equivalents. Bioaccessibility of total carotenoids was determined as 2.1% with in vitro digestion. Pretreatment with crude BM extract significantly reduced weight loss, macroscopic, and microscopic colitis damages in colonic samples (P = .000), (P = .015), and (P = .026), respectively. Serum anti-inflammatory cytokine IL-10 increased significantly in both treatment groups (P = .000). BM is a rich source of carotenoids, but the bioaccessibility of its carotenoids is low. This study displays that BM has protective anti-inflammatory effects on TNBS-induced colitis., Ege University Scientific Research ProjectsEge University [ID/number: 80/2017-TIP-007], This study was funded by the Ege University Scientific Research Projects (Project ID/number: 80/2017-TIP-007).

[No Abstract Available]

Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient's demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and

Amaç: Pankreas kanserlerinin epidemiyolojisi ve genel sağkalım (GSK) özelliklerinin araştırılmasıdır.Gereç ve Yöntem: Ege Üniversitesi Kanserle Savaş Uygulama ve Araştırma Merkezine (EÜKAM) 1992-2017 yıllarında kayıtlı Ege Üniversitesi Tıp Fakültesi (EÜTF) kanser verileri retrospektif olarak taranmıştır. CANREG özel bilgisayar programına kayıtlı veriler, WHO ve Surveillance, Epidemiology, and End Results (SEER) sistemlerinde gruplanarak analizler yapılmıştır. İstatistiksel analizlerde Ki-kare, General Linear Model (GLM), Kaplan-Meier sağ kalım analizleri kullanılmıştır.Bulgular: Toplam 117.139 kanser olgusunun 2.507’si pankreas kanseridir. Olgularımızın 1.493’ü (%59,5) erkek, 1.014’ü (%40,5) kadın olup pankreas kanseri iki cinsiyette benzer oranlarda izlenmektedir. Pankreas başı, en sık yerleşim yeridir. Genellikle ileri evrede tanı konulan kuyruk yerleşimli tümörler, erkeklerde daha sıktır (%11,5 vs. %6,2; p=0,047). Erkeklerde en sık 60 69 yaş arasında, kadınlarda ise 70 yaş üzerinde izlenmektedir. Ekzokrin tümörler, endokrin tümörlerden anlamlı oranda fazla karşılaşılmaktadır (%95 vs. %5; p=0,002). 1992 yılından 2014 yılı sonuna kadar kaydedilen pankreas kanseri olgularında doğrusal bir artış mevcuttur ve yıllara göre olan bu artış anlamlıdır (GLM: F=10,91, p, Aim: To determine epidemiological and overall survival (OS) characteristics of pancreatic cancer patients.Materials and Methods: Data of Ege University Cancer Control and Research Center between 1992-2017 were screened retrospectively. Data recorded in CANREG program were grouped and analyzed in WHO and Surveillance, Epidemiology, and End Results (SEER) systems. Chi-square test, General Linear Model (GLM) and Kaplan-Meier survival analysis were used for statistical analysis.Results: Number of pancreatic cancer cases was 2,507 among 117,139 cancer cases. 1,493 (59.5%) of our cases were male and 1,014 (40.5%) were female. Pancreatic head was the most common location. Tail located tumors were more common in males (11.5% vs. 6.2%; p =0.047). It was most common in males between the ages of 60 and 69, in females over the age of 70. Exocrine tumors were significantly higher than endocrine tumors (95% vs. 5%; p=0.002). There was a linear increase in pancreatic cancer cases recorded from 1992 to the end of 2014, and this increase over the years was significant (GLM: F=10.91, p

Background/Aims: Ledipasvir (LDV) and sofosbuvir (SOF) as single-tablet regimen (STR) has been approved for treatment of chronic HCV infection (CHC) for treatment-naive or experienced cirrhotic or non-cirrhotic patients. Our aim was to analyse the effectiveness and safety of 12-24 weeks treatment of LDV/SOF (90mg/400 mg)+/- ribavirin in a real-life setting in Turkey. Materials and Methods: Between May-Dec 2016, 104 treatment-naive or experienced adult patients with CHC and with or without cirrhosis (including decompensated cirrhosis) were included in this observational study. Patients were administered LDV/SOF STR +/- ribavirin once daily for 12-24 weeks. SVR12 rates and effects of the baseline characteristics on SVR12 rates were assessed. Results: Out of 104 enrolled patients (61.5% female, mean age 62.0 years); 60.6% were cirrhotic, 76.0% previously used peg-IFN, 94.2% had GT1. At the end of the treatment, 77.8% (77/99, no data for 21 patients) had undetectable HCV-RNA and 98.9% (94/95) had SVR12. in the baseline characteristics subgroups, the SVR12 rates varied between 94.4% and 100%, and none of the baseline characteristics had a significant effect on the SVR12 rates. During the study, 6 (5.8%) patients died and none of the deaths was suspected to be related to the LDV/SOF. No treatment-emergent adverse event was reported. Conclusion: in conclusion, LDV/SOF +/- ribavirin yielded very high SVR12 rates, without any safety or tolerability concern in Turkey. the effectiveness of the LDV/SOF treatment was not affected by the patient demographics or medical characteristics such as fibrosis level, cirrhosis status, previous treatment status, HCV-RNA level or HCV genotype., Gilead Sciences, TurkeyGilead Sciences, This study was supported by Gilead Sciences, Turkey for editorial support in the preparation of this manuscript.

BACKGROUND/AIMS: The solid pseudopapillary neoplasms are quite rare tumors of the pancreas, comprising roughly 1–2% of all pancreatic neoplasms. It has a low malignant potential and usually affects young females. Despite increasing number of articles in the last decade, there is still debate on the pathogenesis, malignant potential and optimal surgical strategy for the solid pseudopapillary neoplasms. MATERIALS AND METHODS: Medical recordings of 326 patients who were operated due to pancreatic mass were retrospectively analyzed. Patient demographics, presenting symptoms, surgical and pathologic characteristics of the tumor, postsurgical course, long-term survival, and other relevant data were extracted from patients’ charts. RESULTS: Majority of the patients were female in consistency with the classic data in the literature. All the patients underwent curative intent resections. Tumors were commonly localized in the tail of the pancreas making distal pancreatectomy the most commonly performed surgical procedure. Mean tumor diameter was 5.8 centimeters with tumor sizes ranging from 1 to 19 cm. CONCLUSION: The solid pseudopapillary neoplasms of the pancreas is a rare tumor with low malignant potential, which is more common in females of reproductive age, with abdominal pain being their most common presentation. The short-term outcomes in patients following surgical R0 resection are excellent. However, proximal placement of the tumor and female gender may have slightly worse prognosis. We hope that our findings from a series of patients represent a contribution to the existing literature on SPN, and authors declare their willingness to provide further details for future meta-analyses.

[Abstract Not Available]

WOS: 000429745000008, Triple-A syndrome is a rare, multi-systemic disease and is characterized by adrenal insufficiency, achalasia, or alacrima. The symptoms may also involve neurologic manifestations, including pyramidal findings and peripheral motor neuropathy. Other findings include autonomic dysfunction and cerebellar ataxia. In the present study, we present the case of two siblings with triple-A syndrome with neurologic manifestations. The neurologic abnormalities can lead to misdiagnosis owing to resemblance to the manifestations of other neurologic disorders. Therefore, the cases with triple-A syndrome should be carefully evaluated and examined for clinical and neurophysiologic signs.

Background The aim of the study was to evaluate the current opinion and clinical decision-making process of international pancreatologists, and to systematically identify key study questions regarding the diagnosis and treatment of chronic pancreatitis (CP) for future research. Methods An online survey, including questions regarding the diagnosis and treatment of CP and several controversial clinical case vignettes, was send by e-mail to members of various international pancreatic associations: IHPBA, APA, EPC, ESGE and DPSG. Results A total of 288 pancreatologists, 56% surgeons and 44% gastroenterologists, from at least 47 countries, participated in the survey. About half (48%) of the specialists used a classification tool for the diagnosis of CP, including the Mayo Clinic (28%), Mannheim (25%), or Buchler (25%) tools. Overall, CT was the preferred imaging modality for evaluation of an enlarged pancreatic head (59%), pseudocyst (55%), calcifications (75%), and peripancreatic fat infiltration (68%). MRI was preferred for assessment of main pancreatic duct (MPD) abnormalities (60%). Total pancreatectomy with auto-islet transplantation was the preferred treatment in patients with parenchymal calcifications without MPD abnormalities and in patients with refractory pain despite maximal medical, endoscopic, and surgical treatment. In patients with an enlarged pancreatic head, 58% preferred initial surgery (PPPD) versus 42% initial endoscopy. In patients with a dilated MPD and intraductal stones 56% preferred initial endoscopic ± ESWL treatment and 29% preferred initial surgical treatment. Conclusion Worldwide, clinical decision-making in CP is largely based on local expertise, beliefs and disbeliefs. Further development of evidence-based guidelines based on well designed (randomized) studies is strongly encouraged.

Background/aims This study aimed to compare the causes of nonvariceal upper gastrointestinal bleeding (NVUGB), demographics, risk factors, and outcomes of patients during two periods between 1993 and 2016 in a tertiary health-care center in Turkey. Materials and methods We compared the causes of NVUGB and clinical outcomes in 421 patients hospitalized between January 1993 and December 1995 with those of 231 patients with NVUGB hospitalized between January 2015 and September 2016. We also compared epidemiological characteristics, risk factors, and the rates of endoscopic hemostatic procedures. Results We observed significant increases in patients' mean age, in the percentage of patients with comorbid conditions, and in the percentage of patients who received direct-acting oral anticoagulants before bleeding. We also observed a statistically nonsignificant increase in the diagnoses of gastric ulcer, along with a significant concordant decrease in diagnoses of duodenal ulcer as a cause of bleeding. The use of emergency surgical hemostasis decreased among cases of peptic ulcer bleeding. The overall rate of mortality from bleeding did not significantly change between the two periods. Conclusion Over the 23 years studied, the causes of NVUGB changed, probably because the population was increasingly elderly population and because of the use of anticoagulants and better therapeutic approaches to chronic duodenal ulcers. The use of emergency surgical hemostasis reduced, but mortality rate did not significantly change between the two specific periods.

INTRODUCTION:Crosstalk between hepatocytes and immune cells is the key point that ultimately leads to inflammation and fibrosis. This is well-known entity underlying the decompansation of liver failure. Recently, it has been shown that the ratio of lymphocyte to monocytes that can be measured easily in peripheral blood reflects many inflammatory processes. In this study, we aimed to find the novel inflammatory parameters predicting subclinical hepatic encephalopathy in patients with liver failure who were routinely followed up in outpatient clinics.METHODS:Seventy-six cirrhotic patients who were followed up in Ege University Medical Faculty Hospital Gastroenterology-Hepatology out-patient clinic were included in the study. Thirteen similar healthy volunteers in terms of age and gender were also recruited. We applied psychometric hepatic encephalopathy score (PHES) and Critical flicker frequency test (CFF) for both patient groups (with and without covert hepatic encephalopathy (CHE)). We analyzed neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), mean platelet volume as well as INR, CRP, albumin, total bilirubines and platelet counts from routine clinic testing samples, retrospectively.RESULTS:According to West-Haven criteria, CHE was detected in 41 patients and not detected in 35 patients. When CFF test was applied, patients with CHE completed by reacting late compared to non-CHE patients (pCONCLUSION:LMR and NLR, which are cheap and easily available hemogram parameters, can provide early warning to clinicians for cirrhotic patients in outpatient follow-up.

GIRIS ve AMAC: Uzun donem Methotrexat kullanimi artmis karaciger hasari ve fibrozis riski ile iliskilidir. Leflunomid hastalik modifiye edici bir ilactir. Leflunomid nukleer faktor kappa B aktivasyonunun guclu bir inhibitorudur. Ayni zamanda anti-oksidan aktivitesi de vardir. Bu deneysel calismada Methotrexat'in neden oldugu karaciger toksisitesinde Leflunomid tedavisinin etkinligi arastirilmistir. YONTEM ve GERECLER: 39 rat 4 gruba ayrilmistir. Methotrexat'a bagli karaciger toksisitesi tek doz 20mg/kg Methotrexat'in periton icine injeksiyonu ile olusturulmustur. Ardindan Leflunomid 5 gun boyunca 10 mg/kg dozda verilmistir. Ardindan serum ornekleri ve homojenize karaciger ornekleri toplanmistir. Serum alanin aminotransferaz, alkalin fosfataz, superoxide dismutaz, myeloperoxidaz aktivitesi, glutatyon duzeyleri calisilmis ve histopatolojik degerlendirme yapilmistir. BULGULAR: Leflunomid tedavisi tedavi almayan gruba gore karaciger semikantitatif skalaya bagli histopatolojik degerlendirmede anlamli duzelme saglamistir (Patolojik skor 1.1+0.7 ve 5.1+2, p

Crigler-Najjar syndrome presents as severe unconjugated hyper-bilirubinemia and is characteristically caused by a mutation in the UGT1A1 gene, encoding the enzyme responsible for bilirubin glucuronidation. Here we present a patient with Crigler-Najjar syndrome with a completely normal UGT1A1 coding region. Instead, a homozygous 3 nucleotide insertion in the UGT1A1 promoter was identified that interrupts the HNF1 alpha binding site. This mutation results in almost complete abolishment of UGT1A1 promoter activity and prevents the induction of UGT1A1 expression by the liver nuclear receptors CAR and PXR, explaining the lack of a phenobarbital response in this patient. Although animal studies have revealed the importance of HNF1 alpha for normal liver function, this case provides the first clinical proof that mutations in its binding site indeed result in severe liver pathology stressing the importance of promoter sequence analysis. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

We aimed to measure the diurnal changes of critical flicker frequency in healthy subjects and cirrhotic patients and to investigate their relationship with sleep disturbance.Cirrhotic patients and healthy volunteers were included. All groups completed the Pittsburgh Sleep Quality Index and a simple sleep questionnaire. Sleep disturbance was defined as a Pittsburgh Sleep Quality Index score of5. Critical flicker frequency was measured twice a day to detect diurnal abnormalities.Overall, 59 cirrhotic patients (54.2% males, Mean Age 59 ± 11 years) and 18 controls (39.9% males, Mean Age 58 ± 9 years) were included. Sleep disturbances were more common in cirrhotics (66.1%) than controls (38.9%, p0.05). In cirrhotics, the critical flicker frequency was not related to decompensation. The nocturnal values were higher than the morning values in cirrhotics (64.4%), but not in controls (p0.0001). Additionally, sleep disturbances were more common in cirrhotics who had higher nocturnal values (p0.05).Changes in the diurnal critical flicker frequency were observed in cirrhotics but not in controls. Sleep disturbances in cirrhotics appear to be associated with deviations of the diurnal rhythm of critical flicker frequency rather than with clinical parameters such as the clinical stages of cirrhosis and the Model For End-Stage Liver Disease and Child-Pugh scores.

WOS: 000388750400045, PubMed ID: 26923781, Background: Aprotinin is a monomeric globular polypeptide, which derived from bovine lung tissue and theoretically attractive molecule in ameliorating the effects of acute pancreatitis. Acute pancreatitis is an inflammatory condition of the pancreas that is painful and at times deadly. Over the following two decades Aprotinin therapeutic potential on pancreatitis is proven experimentally, its clinical therapeutic success is limited due to low targeting to pancreas. Objective: The aim of this study was to evaluate the biodistribution of Technetium-(99m)(Tc-99m)Aprotinin solution (Tc-99m-Aprotinin-S) and Tc-99m-Aprotinin loaded microemulsion, which was prepared for the aim of treatment for acute pancreatitis. Method: Aprotinin was radiolabeled with Tc-99m. Radiochemical purity was determined with radioactive thin layer chromatography studies. Tc-99m-Aprotinin-S and Tc-99m-Aprotinin loaded microemulsion (Tc-99m-Aprotinin-M) was administered to acute edematous, severe necrotizing pancreatitis and air pouch model induced rats. Tissue distribution of Aprotinin was investigated with gamma scintigraphy and biodistribution studies. Results: Aprotinin was radiolabeled by Tc-99m with high radiochemical purity (95.430 +/- 0.946%). The complex was found to be stable at room temperature up to 6 h. Animal studies have shown that similar to that of other small proteins Aprotinin is accumulated primarily in the kidney. The scintigraphy and biodistribution studies showed that, while i. v. administration of (99m)TcAprotinin-S distributed mostly in kidneys and bladder, Tc-99m-Aprotinin-M, with droplet size of 64.550 +/- 3.217 nm, has high uptake in liver, spleen and pancreas. Conclusion: This might be concluding that microemulsions may be suggested as promising formulations for selectively targeting Aprotinin to pancreas inflammation., Scientific and Technological Research Council of Turkey (Tubitak)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [108S083]; T.R. Prime Ministry State Planning Organization FoundationTurkiye Cumhuriyeti Kalkinma Bakanligi [09DPT001], The authors declare no conflict of interest. The authors alone are responsible for the content and writing of the article. This study was supported by The Scientific and Technological Research Council of Turkey (Tubitak 108S083). The authors also thank to the T.R. Prime Ministry State Planning Organization Foundation (Project Number: 09DPT001).

Myasthenia gravis is an antibody-mediated autoimmune disease at the neuromuscular junctions. It can be associated with many other autoimmune diseases. We report a case of acute presentation of autoimmune hepatitis with myasthenia gravis, thymoma, Hashimoto thyroiditis and connective tissue disorder.

Celiac disease is a gluten-induced enteropathy controlled by gluten restriction. Celiac disease is occasionally associated with T-cell lymphoma. We report a case with celiac disease who presented with duodenal ulcer-like symptoms and endoscopic findings. The persistent symptoms despite a strict diet led to the suspicion of an associated malignancy. Intensive evaluation revealed a case with celiac disease associated with B-cell lymphoma. Although B-cell lymphoma is rare, it should be kept in mind especially in female patients with persistent symptoms and refractory celiac disease.

Background: Eradication rates of Helicobacter pylori have declined to unacceptable levels in recent years. New and effective treatment options are warranted both as a first and second line treatment. Aim: To test an effectiveness of modified sequential therapy with levofloxacin for H. pylori eradication in Turkey. Material and Methods: Helicobacter pylori infected dyspeptic patients were included to the study. Subjects were treated with modified sequential therapy consisting of rabeprazole 20 mg b.i.d. and amoxicillin 1 g b.i.d., for 7 days followed by rabeprazole 20 mg b.i.d, levofloxacin 500 mg q.d. and metronidazole 500 mg b.i.d for the remaining 7 days. Results: Sixty-three treatment naive patients and 37 previous treatment failures were enrolled to the study (59 F, 41 M, age: 21–80 years). There was five drop out. Helicobacter pylori eradication was achieved in 80 patients, intention-to-treat (ITT): 80% (95% CI: 71–87%) and per-protocol (PP): 84.2% (95% CI: 75–91%), totally. In treatment naive patients ITT and PP eradication rates were 82.5% (95% CI: 71–91%), and 86.7% (95% CI: 75–94%), respectively. As a second line treatment eradication was successful in ITT 75.7%.(95% CI: 59–88%), and PP 80% (95% CI: 63–92%).Mild side effects were reported by 8 patients (8.4%). Conclusions: Sequential therapy using “rabeprazole and amoxicillin 7 days followed by rabeprazole, metronidazole and levofloxacin for 7 days” is a new regimen with acceptable eradication rates in naive patients in Turkey. Further modifications in the dose or duration of this new sequential therapy might increase its effectiveness as both first and second line treatment.

Background: Non-alcoholic fatty liver disease (NAFLD) is common in obese and diabetics. Serine protease inhibitor Kazal-1 (SPINK-1) protein is highly expressed in the liver and adipose tissue of diabetic and obese suggesting its role in NAFLD. SPINK-1 also behaves as an acute phase reactant protein. Some genetic factors including the genetic variations in SPINK-1 protein have been linked to chronic pancreatitis and diabetes. We therefore hypothesized that SPINK-1 mutations might be a risk factor for the development of NAFLD. Methods: Liver biopsy proven fifty NAFLD cases (20 steatohepatitis, 30 diffuse fatty liver disease and 44 healthy controls were included to the study. Liver function tests were measured. Body mass index was calculated. Insulin resistance was determined by using a homeostasis model assessment (HOMA-IR). Ultrasound evaluation was performed for each subject. Common genetic mutations in the third exon of SPINK-1 gene were analyzed by direct sequencing method. Results: We found two cases with a SNP at N34S location in NAFLD group (allele frequency %4). One subject with diffuse fatty liver disease and other with liver cirrhosis due to NAFLD had N34S mutation. No SNPs were detected in healthy controls. In conclusions, in limited number of patients SPINK-1 mutations were not considered as a risk factor alone for NAFLD development.

BACKGROUND/AIMS Pancreatic cystic lesions have a broad spectrum of differential diagnosis. There is an ongoing demand to identify specific and sensitive cystic fluid markers for the differential diagnosis of pancreatic cysts. We aimed to evaluate the diagnostic value of cystic fluid chromogranin A (CgA) in the differential diagnosis of pancreatic cysts. MATERIALS AND METHODS Patients who underwent endoscopic ultrasound (EUS)-guided aspiration for pancreatic cysts were included in the study. Cytopathological analysis and biochemical analysis, including cystic fluid carcinoembryonic antigen (CEA), amylase, Ca 19-9, and CgA, were performed. RESULTS Fifty-three patients were included in the study. The final diagnosis of patients was 14 pancreatic pseudocysts, 10 intraductal papillary mucinous neoplasms (IPMNs), 8 mucinous cystic neoplasms (MCN), 8 serous cystadenomas (SCAs), 2 cystic pancreatic neuroendocrine tumors (PNETs), and 11 others. The mean CgA levels were 50.51±130.04 ng/mL in pseudocysts, 12.38±8.59 in MCN, and 13.76±10.90 in cystic PNET. There was only one patient with a very high cystic fluid CgA (515.49 ng/mL) and was diagnosed as pseudocyst developed in chronic pancreatitis patient. Two patients with cystic PNET had normal levels of cystic fluid CgA. CONCLUSION Cystic fluid CgA is not a useful marker for the differential diagnosis of cystic PNETs. It also has no value in the differential diagnosis of other pancreatic cysts.

Background/Aims: The diagnosis of an underlying myeloproliferative neoplasm (MPN) is often problematic in patients with Budd Chiari syndrome (BCS) or portal vein thrombosis (PVT). This study aimed to assess the diagnostic value of the JAK2 gene V617F gain-of-function mutation for MPN in splanchnic vein thrombosis patients. Materials and Methods: One hundred eleven patients (80 with PVT, 27 with BCS, and 4 with BCS and PVT) were investigated. The control group included 56 volunteers without any known diseases. LightCycler SNP genotyping was performed to detect the JAK2 V617F mutation in DNA extracted from peripheral blood. Results: The JAK2 V617F mutation was identified in six of 28 patients (21.4%) with idiopathic PVT or BCS and in eight of 45 patients (17.8%) with PVT or BCS secondary to a known prothrombotic factor, but in only one of 38 patients (2.6%) with PVT and cirrhosis (p=0.049). Conclusion: The JAK2 V617F mutation is a noninvasive molecular marker for occult MPNs and can be used for the diagnosis of latent MPNs presenting with thrombotic events. Analysis of JAK2 mutation in the patients with idiopathic PVT or BCS showed that 20% had latent MPNs. In addition to this JAK2 mutation, prothrombotic events were observed in a significant number of patients with splanchnic vein thrombosis. JAK2 gene analysis should be included in the research panel for BCS and PVT patients without cirrhosis.

WOS: 000395365500001, PubMed ID: 28261279, Gastroenteropancreatic neuroendocrine tumors (GEPNETs) are a relatively rare, heterogeneous group of diseases in which important advances have been observed in the diagnosis and treatment as well as in our understanding of the biology and genetics of the disease in recent years. Given the insufficient scientific data available on evidence-based management of GEPNETs and the differences in circumstances in individual countries, a multidisciplinary study group was established to provide guidelines for the management of GEPNETS. This study group consisted of a medical oncologist, endocrinologist, surgeon, pathologist, gastroenterologist, and a nuclear medicine specialist, who aimed to prepare a practical guide in the light of existing scientific data and international guidelines, to be used in common clinical practice., RocheRoche Holding; PfizerPfizer; Celgene, Suayib Yalcin has had advisory board role in Novartis, Roche, Pfizer, Amgen and speaker Bureau role for Gen ilac, Novartis, Roche, Pfizer and travel grant from Roche and Pfizer, and research grant from Celgene.

The aim of this study was to develop aprotinin-loaded microemulsion (MA) for intravenous administration and evaluate the biodistribution and therapeutic potential of developed formulation in acute pancreatitis models in rats. Phase diagrams were constructed to identify microemulsion region and the optimal microemulsion was evaluated for physicochemical properties and treatment effect in rats, and comparisons made with the solution of aprotinin (SA). To evaluate the biodistribution of the drug by gamma scintigraphy aprotinin was radiolabeled with (99m)Tc radionuclide. Mild and severe acute pancreatitis was induced in rats by subcutaneous injections of cerulein and introductal infusion of 3% sodium taurocholate into the bile-pancreatic duct, respectively. In addition, serum amylase and pancreatic tissue myeloperoxidase activities were measured to evaluate the pancreatic damage. According to gamma scintigraphy and biodistribution studies, accumulation times and distribution of (99m)Tc-MA and SA were different. While MA was highly uptake by reticuloendothelial system, SA was mostly excreted by kidneys and bladder. Compared with the mild acute pancreatitis group, treatment with MA significantly decreased the serum amylase activity and pancreas myeloperoxidase activity. Furthermore, the protease inhibitor molecule aprotinin has therapeutic potential in acute pancreatitis. Finally, MA may be suggested as a promising alternative for treatment of acute pancreatitis.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell (HSC) lines due to a somatic mutation of the phosphatidylinositol glycan anchor (PIG-A) gene located on Xp22.1. PNH incidence is 1.5-2 cases per million of the population per year. PNH can affect multiple systems in the body and requires multidisciplinary clinical management. Patients can manifest with severe pancytopenia, life-threatening thrombosis affecting the hepatic, abdominal, cerebral, and subdermal veins, and high requirements for blood transfusion due to haemolytic anemia. PNH can also be associated with bone marrow failure. Advances in diagnostic techniques and a targeted therapeutic approach for PNH have emerged in the last two decades. Eculizumab, a promising humanized monoclonal antibody against C5, is the first approved therapy for PNH.

Alcoholic chronic pancreatitis is a severe, disabling, chronic inflammatory condition of the pancreas that is seen in fewer than 5% of alcoholics. The severity and unpredictability of this condition has lead to several theories on the mechanism causing chronic pancreatitis based on careful clinical observation. Hypothetical mechanisms were applied to various animal models. Finally, following multiple lines of evidence, there is a convergence of thought and development of some new models that are quite instructive. Taken together, chronic alcohol consumption by rats results in multiple effects on the pancreas that increase the risk of acute pancreatitis, including ongoing acinar cell injury that lowers the threshold for hyperstimulation-induced acute pancreatitis, neurohormonal injury, and adaptation that results in acinar cell hyperstimulation, increased susceptibility to viral mediated acute pancreatitis, and possibly other factors. After acute pancreatitis initiates the inflammatory process, the chronic inflammation and fibrosis of alcoholic chronic pancreatitis are driven by diet, the acinar cell stress response to continued alcohol that may be potentiated by toxic alcohol metabolites, hypoxia, hyperstimulation, and partial duct obstruction; plus the effects of proinflammatory immunocytes and cytokines; and by stellate cell-mediated fibrosis driven by anti-inflammatory cytokines, alcohol, and alcohol metabolites. The factors determining which alcoholic will develop alcoholic chronic pancreatitis likely involve genetic factors, dietary factors, and susceptibility to pancreatic injury through several mechanisms ranging from trauma to gallstones to viruses.

OBJECTIVES Acute pancreatitis is a multifactorial disease caused by activation of several inflammatory mediators. Leukotrienes, beside other mediators, may be involved in acute pancreatitis. The aim of this study was to investigate the effects of 'zafirlukast', a leukotriene receptor antagonist, in acute pancreatitis and its relation with prostaglandin synthesis. METHODS Eighty rats were randomly divided into eight groups. Acute pancreatitis was induced by subcutaneous injection of cerulein (20 microg/kg), four times at 1-h intervals. Zafirlukast (20 mg/kg) was applied intraperitoneally as a pretreatment. Prostaglandin synthesis was inhibited by low-dose indomethacin (5 mg/kg subcutaneously). Pancreatic histopathology, serum amylase activity and pancreatic myeloperoxidase activity were determined to assess the severity of pancreatitis. RESULTS Zafirlukast pretreatment alone did not induce any inflammation and fatty necrosis in pancreatic tissue. However, it increased the histopathological score from 3.70 +/- 0.57 to 6.62 +/- 0.53 in rats with acute pancreatitis (P < 0.001). Fatty necrosis was especially prominent in the zafirlukast-treated acute pancreatitis group compared with the untreated group (2.62 +/- 0.26 versus 0.40 +/- 0.22, respectively; P < 0.001). Inhibition of prostaglandin synthesis by indomethacin partially suppressed the harmful effects of zafirlukast in acute pancreatitis. It decreased the pathological score (4.62 +/- 0.73) and fatty necrosis (1.50 +/- 0.32) in that group. CONCLUSION Interestingly, leukotriene receptor antagonism by zafirlukast increased the pancreatic histopathological score and fatty necrosis in rats with acute pancreatitis. Blocking of cysteinyl leukotriene receptors might cause an induction of mediator synthesis via other pathways. Effects of leukotriene receptor antagonism on the pancreas must be evaluated extensively in further studies.

We aimed to evaluate the protective effects of pentoxifylline on alcohol-induced gastric injury, its relation with nitric oxide and prostaglandin synthesis, as well as gastric acidity in rats. Acute gastric mucosal injury was induced by intragastric infusion of 2 ml 98% alcohol. Pentoxifylline was given at 100 mg/kg intraperitoneally. Indomethacin and NG-nitro-L arginine were used to inhibit prostaglandin and nitric oxide synthesis, respectively. Macroscopic and microscopic gastric injuries were evaluated. Gastric pH, tissue malondialdehyde levels, oxidized and reduced glutathion (GSSG/GSH) levels, and effects of pentoxifylline on gastric acid output were measured. Pentoxifylline pretreatment significantly reduced macroscopic and microscopic gastric injury. Malondialdehyde level was lower in pentoxifylline treated rats (351.1 ± 94.1 nmol/g vs 624.3 ± 234.2 nmol/g). Pentoxifylline has a protective role on alcohol-induced gastric mucosal injury in rats. This effect is not related to synthesis of prostaglandins and changes in gastric acidity but does seem to be related to nitric oxide-mediated pathways. In contrast, pentoxifylline increases gastric acid output significantly.

BACKGROUND: Many interrelationships exist between the thyroid gland and the gastrointestinal tract. Several past and recent studies have shown that the thyroid gland profoundly influences the structure and function of the exocrine pancreas in the rat. In the present study we investigated the effect of methimazole (METZ), an antithyroid drug, on cerulein induced acute pancreatitis (AP) in rats. METHODS: Rats were divided into 3 groups (10-12 weeks age, 200-250 g weight, n: 10). Group B was made hypothyroid with methimazole 5 mg/kg daily for 10 days and the others were untreated euthyroid groups. After 10 days, acute pancreatitis was induced with four doses of 20 microg/kg body weight of cerulein administered s.c at hourly intervals in group A and B while the control group C was given 4 doses of I ml saline. Pancreas wet weight (mg), plasma amylase activity (IU/l) and pancreatic histology were used as endpoints to quantify the severity of the AP. RESULTS: Plasma tri-iodothyronine (T3) (ng/dl) and thyroxine (T4) (microg/dl) levels were significantly reduced after METZ treatment for 10 days (p < 0.01). METZ pretreatment reduced significantly the cerulein induced increase in pancreatic weight (1,205 +/- 12 mg in METZ treated AP group versus 1,617 +/- 14 mg in AP group, p < 0.05) and the rise in amylase activity (7,078 +/- 816 IU/l in METZ treated AP group versus 8,611 +/- 830 IU/l in AP group p < 0.05). CONCLUSION: METZ reduces the severity of cerulein induced AP in rats. This effect might be through its antithyroid property.

Background & Aims The association between pancreatic intraductal papillary mucinous neoplasms (IPMNs) and extrapancreatic neoplasms (EPNs) is controversial. We performed a multicenter observational study to assess the incidence of EPNs after an IPMN diagnosis. Methods 1340 patients with IPMNs were evaluated from 2000 through 2013 at 4 academic institutions in Europe for development of EPN. To estimate the actual incidence of EPN, we excluded patients with an EPN previous or synchronous to the IPMN, and patients who had been followed for less than 12 months, resulting in a study population of 816 patients. The incidence of EPN was compared with sex-specific, age-adjusted European cancer statistics; the standardized incidence ratio (SIR), and the 5- and 10-year cumulative incidence rates were calculated. Results A total of 290/1340 patients had a history of EPN (prevalence of 21.6%). In this subgroup of patients, the IPMN was discovered incidentally in 241. Among the 816 patients included in the incidence analysis, 50 developed an EPN after a median time of 46 months from study enrollment. The incidence of any EPN was not greater in patients with than without IPMN with a SIR of 1.48 (95% confidence interval, 0.94–2.22) in males and of 1.39 (95% CI 0.90–2.05) in females. The 5- and 10-year cumulative incidence rates for development of EPN in patients with IPMN were 7.9% and 16.6% in men, and 3.4% and 23.1% in women. Conclusions Patients with IPMN do not have a significantly higher incidence of EPNs than the general European population. It might not be necessary to screen patients with IPMN for EPN.

Qualitative and quantitative abnormalities of fibrinogen can result in hemostatic disorders (1). Congenital afibrinogenemia is a rare coagulation disorder transmitted as an autosomal recessive trait (2). The incidence of afibrinogenemia is 1–2 cases per million population (3). It is more common in populations with a high rate of consanguinity (3). Symptoms of afibrinogenemia vary from mild hemorrhagic events to severe bleeding episodes, though thrombotic events are very rare. We report an afibrinogenemic patient who presented with hepatic venous thrombosis at 16 years old. Evaluation of all hemostatic parameters and coagulation factors revealed no other pathology except afibrinogenemia. Paradoxically, afibrinogenemia may be a risk factor for vascular thrombotic events like Budd–Chiari Syndrome (BCS).

Myasthenia gravis is an antibody-mediated autoimmune disease at the neuromuscular junctions. It can be associated with many other autoimmune diseases. We report a case of acute presentation of autoimmune hepatitis with myasthenia gravis, thymoma, Hashimoto thyroiditis and connective tissue disorder.

Human Cytochrome P450 (CYP) comprises a multigene family of microsomal enzymes that metabolize a wide variety of xenobiotics, including drugs and carcinogens. Although the a number of CYP enzymes were also detected in epithelial cells along the gastrointestinal tract, little is known about the expression of CYP genes in gastric tissue.In this study, the expression patterns of CYP isoforms was investigated in a total of 14 antral biopsy tissues obtained from the patients with either chronic gastritis (n = 6) or cancer (n = 8) by gene-specific real-time reverse transcriptase -PCR analyses. We employed primer sets specific for CYPs -1A1, -1A2, -2A6, -2B6, -2C, -2D6, -2E1, and -3A5.Among the isoforms CYP1A1, CYP2C and CYP2D6 gave rise to detectable mRNAs in all 14 gastric tissues while the mRNAs for the other CYPs were detected in some of the tissues. The expression patterns were compared to clinical parameters. There were no significant differences in the parameters between the two groups; however the mRNA expression of CYP2A6 was significantly higher in women than man (p0.05).Our data suggests that the CYP isoforms were independently expressed with respect to the pathological status in human gastric tissue.