Oğuz Üsküdar - Academia.edu (original) (raw)

Papers by Oğuz Üsküdar

PubMed, Mar 1, 2022

The therapeutic options in portal vein thrombosis cases of young age and low weight, as in this c... more The therapeutic options in portal vein thrombosis cases of young age and low weight, as in this case, are limited. Interventional radiologists also have minimal experience in pediatric patients. There are no reported cases anywhere worldwide, especially in this age group. However, we think that balloon angioplasty can be safely applied in cases in which esophageal variceal bleeding cannot be controlled using traditional treatment.

Objectives Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also... more Objectives Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also develop in noncirrhotic livers. In the present study we explored associated risk factors for HCC without cirrhosis and compared patient and tumor characteristics and outcomes in HCC patients with and without underlying cirrhosis. Methods Patients with HCC diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Patients were categorized according to the presence of cirrhosis on the basis of histology or combined radiological and laboratory features. Results In total, 19% of the 1221 HCC patients had no underlying cirrhosis. Noncirrhotic HCC patients were more likely to be female and to have nonalcoholic fatty liver disease or no risk factors for underlying liver disease, and less likely to have hepatitis C virus or alcohol-related liver disease than did cirrhotic HCC patients. HCCs in noncirrhotic livers were more often unifocal (67 vs. 48%), but tumor size was significantly larger (8 vs. 4 cm). Despite the larger tumors, more patients underwent resection (50 vs. 10%) and overall survival was significantly better than in cirrhotics. In multivariate analyses, absence of cirrhosis [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.38-0.63] and presence of hepatitis B (HR 0.68, 95% CI 0.51-0.91) were independent predictors for lower mortality, whereas hepatitis C virus was associated with higher mortality (HR 1.32, 95% CI 1.01-1.65). Conclusion HCC without cirrhosis was strongly associated with female sex and presence of nonalcoholic fatty liver disease or no risk factors for underlying liver disease. In absence of cirrhosis, resections were more often performed, with better survival despite larger tumor size.

Indian Journal of Gastroenterology, Apr 1, 2023

European Journal of Gastroenterology & Hepatology, Sep 12, 2022

Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and ... more Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and is second in cancer-related deaths.. In HCC, whose prognosis is still not good despite current treatments, there is a need for prognostic markers as well as early diagnosis. Glypican (GPC)-3 has been proposed as a potential serologic and histochemical marker speci c to HCC. The aim of this study was to determine the relationship between GPC3 overexpression and HCC prognosis and clinicomorphologic features. Patients and methods: In total 152 patients patients who were diagnosed as a result of hepatectomy, lobectomy, or liver transplantation were enrolled. The patients were divided into two groups as GPC3positive (>10%) and GPC3-negative (<10%). The demographic data of the patients ,tumor characteristics , survival times were recorded. Results: Survival was signi cantly lower in the GPC3+ group. In the multivariate analysis, hepatitis C, AFP, tumor number, tumor focality, portal vein tumor thrombosis, and GLP3 positivity were found to be independent risk factors on survival. Conclusion: Our study showing that GPC3 overexpression is a poor prognostic factor in HCC.GLP3 positivity were found to be independent risk factors on survival.

European Journal of Gastroenterology & Hepatology

Objectives Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increa... more Objectives Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increases with age. The risk of developing HCC is highest in the seventh decade. In this study, we aimed to determine the clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC in the elderly and young populations. Methods All patients aged ≥18 years who were diagnosed histologically between 2016 and 2020 were included in the study. Patients were divided into two groups: <70 years and ≥70 years. The clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC were compared in the elderly and young populations. Results A total of 407 patients were evaluated. There were 164 patients (40.3%) in the geriatric age group. There was no significant difference in the female/male ratio, the laboratory values, survival time between the two groups. There was no significant difference between the two grou...

Digestive Endoscopy, Dec 27, 2011

A 65-year-old man was admitted to hospital with right upper quadrant pain, fever and jaundice. Ph... more A 65-year-old man was admitted to hospital with right upper quadrant pain, fever and jaundice. Physical examination was consistent with cholangitis. Laboratory studies revealed leukocytosis, elevated liver enzymes, and hyperbilirubinemia; and ultrasonographic examination revealed dilated bile ducts with stone images in it. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and during the procedure, the papilla was not observed in the normal location; indeed it was located in the deformed bulb of the duodenum just before a partial apical stricture. Due to the deformity in this region, positioning of the papilla with a side-viewing duodenoscope was not possible for intervention. A normal gastroscope (Olympus GIF-H-260, Olympus Optical, Tokyo, Japan) was inserted. An excellent view and position for the procedure was achieved (Fig. 1). The bile duct was cannulated, the papilla was dilated with a dilation balloon, and stone and bile sludge extraction with a stoneextraction balloon was carried out (Fig. 2). The patient was discharged the day after the procedure without any complications. Ectopic opening of the common bile duct (CBD) into the bulb of the duodenum has been reported in 0.43% of patients undergoing ERCP. It is reported that the ectopic opening of the CBD in the duodenal bulb was not an incidental finding, but a pathological condition that can be associated with recurrent or intractable duodenal ulcer, recurrent biliary pain, choledocholithiasis or acute cholangitis. Deformity and stenosis in the bulb can be as high as 49% in these patients and cannulation of CBD may not be possible due to this deformity in some of them. In some of these patients we recommend that the procedure is carried out with a gastroscope, as in our case, which may supply a better working position. Balloon dilation instead of sphincterotomy is preferred due to the increased risk of perforation in these patients.

Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of mu... more Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of multiple sclerosis (MS). However, both drugs rarely cause liver toxicity (1, 2). Herein, we present a patient with MS who developed severe hepatotoxicity while using interferon after pulse methylprednisolone therapy. A 28-year-old woman was visited in the Gastroenterology Outpatient Clinic because of elevated liver enzymes after intake of interferon-β 1b for attack of MS on May 2007. In her past medical history, she was diagnosed with MS in August 2006. After the diagnosis, she received 1000 mg per day intravenous methylprednisolone for seven consecutive days. During the steroid therapy, her liver function tests were normal. In October 2006, she had a second attack of MS and received another course of 1000 mg per day methylprednisolone therapy. However, on the third day of the treatment (November 2006), her liver enzymes elevated. She developed her third attack in March 2007 when she received 1000 mg per day methylprednisolone for five consecutive days. She began to use 0.3 mg interferon-β 1b (Betaferon) every other day, at the beginning of April 2007 (two weeks after methylprednisolone therapy). The baseline liver function tests were normal. One month after beginning of interferon-β 1b, serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased. The overall follow-up course of the patient is summarized in Table 1. On admission to the Gastroenterology Ward, she had no complaints and her physical examination was normal. She denied abuse of illicit drugs or alcohol. She had no history of liver disease or drug reaction. She was not taking any concomitant drugs, vitamins or herbal supplements. Complete blood count, prothrombin time and biochemical tests other than liver enzymes were within normal limits. Viral (hepatitis serology and atypical viral serologies including Epstein-Barr virus [EBV], cytomegalovirus [CMV] and herpes simplex virus [HSV]) and autoimmune serologies were all negative. The serum level of immunoglobulin G (IgG), ceruloplasmin and |α |1-antitrypsin, iron profile, thyroid function tests were also normal. Hepatobiliary ultrasonography was normal too. Interferon-β 1b was discontinued. Her liver enzymes continued to rise and peaked on the 17 day after cessation of the therapy. She had an ALT of 875 (Nl: <41) IU/L, AST of 501 (Nl: <40) IU/L, |γ|-glutamyl transferase (GGT) of 111 (Nl: <55) U/L, total bilirubin of 4.66 (Nl: < 1.1) mg/dL, direct bilirubin of 3 (Nl: <0.3) mg/dL and prothrombin time of 21 (Nl: 10-14) sec. Liver biopsy performed showed moderate lobular inflammation, centrilobular confluent necrosis, bridging necrosis accompanied with porto-portal and porto-central fibrosis. After some supportive management, prothrombin time returned to normal

Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of mu... more Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of multiple sclerosis (MS). However, both drugs rarely cause liver toxicity (1, 2). Herein, we present a patient with MS who developed severe hepatotoxicity while using interferon after pulse methylprednisolone therapy. A 28-year-old woman was visited in the Gastroenterology Outpatient Clinic because of elevated liver enzymes after intake of interferon-β 1b for attack of MS on May 2007. In her past medical history, she was diagnosed with MS in August 2006. After the diagnosis, she received 1000 mg per day intravenous methylprednisolone for seven consecutive days. During the steroid therapy, her liver function tests were normal. In October 2006, she had a second attack of MS and received another course of 1000 mg per day methylprednisolone therapy. However, on the third day of the treatment (November 2006), her liver enzymes elevated. She developed her third attack in March 2007 when she recei...

The Turkish journal of gastroenterology, Dec 1, 2011

1. Turk J Gastroenterol. 2011 Dec;22(6):651-2. Giant fibroepithelial polyp of the anus. Yilmaz B,... more 1. Turk J Gastroenterol. 2011 Dec;22(6):651-2. Giant fibroepithelial polyp of the anus. Yilmaz B, Coban S, Usküdar O, Unverdı H, Aktaş B, Yüksel O. Dışkapı Yıldırım Beyazıt Educational and Research Hospital, Department of Gastroenterology, Ankara, Turkey. ...

Canadian journal of gastroenterology & hepatology, 2018

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of t... more Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD <5cm to 56.4% with tumors of MTD >10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared...

Acta gastro- …, 2008

... Giant hepatic paraganglioma succesfuly treated with embolisation. Auteur(s) / Author(s). USKÜ... more ... Giant hepatic paraganglioma succesfuly treated with embolisation. Auteur(s) / Author(s). USKÜDAR Oguz (1) ; ZENGIN Neslihan (2) ; KÖKLÜ Seyfettin (1) ; YÜKSEL Ilhami (1) ; BASAR Omer (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ...

Endoscopy, 2009

Fig. 1 A mass on the left parotid gland. UCTN-Unusual cases and technical notes E53 Gültuna S et ... more Fig. 1 A mass on the left parotid gland. UCTN-Unusual cases and technical notes E53 Gültuna S et al. Transient parotitis after conscious sedation for endoscopy … Endoscopy 2009; 41: E53 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and ... more Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and is second in cancer-related deaths. . In HCC, whose prognosis is still not good despite current treatments, there is a need for prognostic markers as well as early diagnosis. Glypican (GPC)-3 has been proposed as a potential serologic and histochemical marker specific to HCC. The aim of this study was to determine the relationship between GPC3 overexpression and HCC prognosis and clinicomorphologic features.Patients and methods: In total 152 patients patients who were diagnosed as a result of hepatectomy, lobectomy, or liver transplantation were enrolled. The patients were divided into two groups as GPC3-positive (>10%) and GPC3-negative (<10%). The demographic data of the patients ,tumor characteristics , survival times were recorded.Results: Survival was significantly lower in the GPC3+ group. In the multivariate analysis, hepatitis C, AFP, tumor number, tumor focality, portal ve...

Video Journal and Encyclopedia of GI Endoscopy, 2013

Fasciola is 15-30-mm long, flat, liver trematode that is endemic in sheep-raising regions. Consum... more Fasciola is 15-30-mm long, flat, liver trematode that is endemic in sheep-raising regions. Consumption of raw aquatic vegetables such as watercress contaminated with metacercariae is the main cause of infection. The disease has three stages: an acute invasive, chronic latent, and chronic obstructive phase. Clinical and laboratory findings are related to the stage of the disease. Ultrasound can detect parasites within the bile duct as hyperechoic motile objects without shadow at the chronic obstructive phase. Biliary sphincterotomy and extraction of Fasciola flukes by balloon or basket are very effective and safe interventions which provide a fast symptomatic response. This article is part of an expert video encyclopedia.

Journal of Translational Science, 2018

Introduction: Several markers of systemic inflammation, including blood C-reactive protein, plate... more Introduction: Several markers of systemic inflammation, including blood C-reactive protein, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) have been identified as independent prognosticators for hepatocellular carcinoma (HCC). Methods: To attempt to understand the significance of these markers, they were examined in relation to 4 tumour parameters, namely maximum tumour diameter (MTD), tumour multifocality, portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. Results: Using linear and logistic regression models, we found that C-reactive protein and PLR on single variables, were statistically significantly related to the tumour parameters. In a logistic regression final model, CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index significantly related to MTD and AFP. Results of the area under the receiver operating characteristic curves (ROC), showed that the areas for PLR and CRP were statistically significant for high versus low MTD and for presence versus absence of PVT. CRP alone was significant for high versus low AFP. Conclusions: These analyses suggest that the prognostic usefulness of the inflammatory markers PLR and CRP (but not NLR) may be due to their reflection of parameter values for tumour growth and invasiveness.

Platelets, 2011

To the Editor Thrombocytopenia is a frequent feature in patients with liver cirrhosis. It has bee... more To the Editor Thrombocytopenia is a frequent feature in patients with liver cirrhosis. It has been mainly attributed to the sequestration of platelets by an enlarged spleen due to portal hypertension which is named as ‘‘hypersplenism’’ [1]. Mechanisms other than hypersplenism such as reduced thrombopoetin or bone marrow suppression also contribute this thrombocytopenia [2]. A 55 year old male was admitted to the hospital with a diagnosis of severe thrombocytopenia. Platelet counts were 4500 m/l and peripheral smear was compatible with it. Patient’s history revealed right nephrectomy twelve years ago due to chronic pyelonephritis and blood transfusion. HCV hepatitis was diagnosed 8 years ago and liver biopsy showed chronic hepatitis with hepatitis activity index 9 and fibrosis score stage 3–4. Patient was treated with ribavirin plus interferon for 6 months but viral eradication could not be achieved. Physical examination revealed splenomegaly without other signs of decompansation. Neither petechiael nor purpuric lesions were observed. Laboratory studies revealed AST: 104 U/l, ALT: 60 U/l, albumin: 3.2 g/dl, creatinine: 0.8 mg, INR: 1.2, WBC: 4500, hemoglobin: 12.2 g/dl. HCV viral load was 816 000 IU/ml with genotype 1. ANA was negative but antithrombocyte antibody was positive. Bone marrow aspiration and biopsy showed increased number of megacaryocytes. (Figure 1) Thrombocytes were filtered in aphaeresis unit and thrombocyte HCV viral load was measured as 5 560 000 IU/Ml which was seven times higher than serum level. Patient did not respond to 14 days steroid (1 mg/kg) treatment and intravenous immunoglobulin (1 g/kg, for 2 days) was administered. Ten days after immunoglobulin administration platelet counts increased up to 300 000/ml. (Figure 2) The degree of thrombocytopenia in HCV patients appears to be significantly greater than other forms of liver disease [3]. Other than aforementioned mechanisms hepatitis C virus can also cause thrombocytopenia as a result of bone marrow suppression resulting from HCV itself or aberrations of the immune system

Digestive Endoscopy, 2012

Dear Editor, The diagnosis of acute appendicitis is frequently based on clinical criteria. Howeve... more Dear Editor, The diagnosis of acute appendicitis is frequently based on clinical criteria. However, to minimize the rate of negative appendectomies (determined as high as 20% in some risky populations, such as young women, and especially with a history of irritable bowel syndrome), ultrasonography and/or computed tomography are the main appropriate imaging modalities. Even with the high specificity and sensitivity rates of these methods, colonoscopic procedures are also reported as a diagnostic examination for acute appendicitis, mostly for delayed or atypical presentations. Here, we report two patients with a diagnosis of acute appendicitis by colonoscopy. The first case was a 26 year-old-woman admitted to our unit with abdominal discomfort for 1 week. Her medical history was negative except for dysmenorrhea, physical examination revealed only mild inguinal tenderness, and laboratory results showed mild leucocytosis. She also had a family history of colon cancer in her first-degree relatives at an early age. Colonoscopy showed a small polyp-like bulging of the appendix with erythematous mucosa and also pus flowing from the internal orifice (Fig. 1). According to the endoscopic view, she underwent appendectomy in view of suspicion of acute appendicitis. A swollen appendix was seen during the surgical operation, so appendectomy was carried out. Histology was consistent with suppurative appendicitis showing a mixed inflammatory infiltrate involving the entire wall of the appendix and focal ulceration of the surface. The second case, a 42-year-old man was referred to our clinic with abdominal computed tomography showing wall thickening at the terminal ileal level. Patients’ history revealed intermittent abdominal pain and discomfort in the right lower abdomen. His physical examination was unremarkable and laboratory results were within normal limits. Colonoscopy carried out to rule out inflammatory bowel disease showed a bulging polypoid hyperemic lesion at the appendiceal orifice (Fig. 2). Subsequently, the patient underwent a right hemicolectomy with a diagnosis of cecal mass lesion. Histological findings revealed xantogranulomatous inflammation consistent with plastrone appendicitis. Some of the patients had the diagnosis of acute appendicitis based on surgical operation and had a history of previous attack, or pain for 2–3 weeks.All the cases ultimately had to go to appendectomy, and in cases of delayed diagnosis, the risk of mortality and morbidity will increase. Therefore, the physicians faced pressure to get an accurate diagnosis as soon as possible. In conclusion, colonoscopic procedure should be an alternative diagnostic modality in patients with atypical presentation of abdominal pain and discomfort, and may be useful for patients with non-diagnostic imaging studies.

The Turkish Journal of Gastroenterology, 2011

Acta gastro-enterologica Belgica

Aim. To present follow-up results of our chronic hepatitis patients infected with HDV treated wit... more Aim. To present follow-up results of our chronic hepatitis patients infected with HDV treated with subcutaneous interferon (IFN). Method. A total of 24 patients, 21 males and 3 females with HBsAg (+), AntiHBc IgM (-), antibody against hepatitis D virus (anti HDV) and/or HDV RNA (+) and with above normal values for serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), who had no contraindications for treatment and had suitable histological activity index (HAI) and fibrosis scores in their liver biopsies were enrolled. Patients treated with three doses of 9-10 MU subcutaneous IFN per week. Serum aminotransferases, HBsAg, antibody against HbsAg (anti HBs), hepatitis B e antigen (HBeAg), antibody against HBeAg (anti HBe), HBV DNA, anti HDV and/or HDV RNA levels were determined before, during and after treatment. Results. Nine patients (37.5%) stopped treatment in an early phase. In 3 patients (12.5%), treatment was discontinued due to severe side effects. In the pos...

PubMed, Mar 1, 2022

The therapeutic options in portal vein thrombosis cases of young age and low weight, as in this c... more The therapeutic options in portal vein thrombosis cases of young age and low weight, as in this case, are limited. Interventional radiologists also have minimal experience in pediatric patients. There are no reported cases anywhere worldwide, especially in this age group. However, we think that balloon angioplasty can be safely applied in cases in which esophageal variceal bleeding cannot be controlled using traditional treatment.

Objectives Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also... more Objectives Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also develop in noncirrhotic livers. In the present study we explored associated risk factors for HCC without cirrhosis and compared patient and tumor characteristics and outcomes in HCC patients with and without underlying cirrhosis. Methods Patients with HCC diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Patients were categorized according to the presence of cirrhosis on the basis of histology or combined radiological and laboratory features. Results In total, 19% of the 1221 HCC patients had no underlying cirrhosis. Noncirrhotic HCC patients were more likely to be female and to have nonalcoholic fatty liver disease or no risk factors for underlying liver disease, and less likely to have hepatitis C virus or alcohol-related liver disease than did cirrhotic HCC patients. HCCs in noncirrhotic livers were more often unifocal (67 vs. 48%), but tumor size was significantly larger (8 vs. 4 cm). Despite the larger tumors, more patients underwent resection (50 vs. 10%) and overall survival was significantly better than in cirrhotics. In multivariate analyses, absence of cirrhosis [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.38-0.63] and presence of hepatitis B (HR 0.68, 95% CI 0.51-0.91) were independent predictors for lower mortality, whereas hepatitis C virus was associated with higher mortality (HR 1.32, 95% CI 1.01-1.65). Conclusion HCC without cirrhosis was strongly associated with female sex and presence of nonalcoholic fatty liver disease or no risk factors for underlying liver disease. In absence of cirrhosis, resections were more often performed, with better survival despite larger tumor size.

Indian Journal of Gastroenterology, Apr 1, 2023

European Journal of Gastroenterology & Hepatology, Sep 12, 2022

Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and ... more Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and is second in cancer-related deaths.. In HCC, whose prognosis is still not good despite current treatments, there is a need for prognostic markers as well as early diagnosis. Glypican (GPC)-3 has been proposed as a potential serologic and histochemical marker speci c to HCC. The aim of this study was to determine the relationship between GPC3 overexpression and HCC prognosis and clinicomorphologic features. Patients and methods: In total 152 patients patients who were diagnosed as a result of hepatectomy, lobectomy, or liver transplantation were enrolled. The patients were divided into two groups as GPC3positive (>10%) and GPC3-negative (<10%). The demographic data of the patients ,tumor characteristics , survival times were recorded. Results: Survival was signi cantly lower in the GPC3+ group. In the multivariate analysis, hepatitis C, AFP, tumor number, tumor focality, portal vein tumor thrombosis, and GLP3 positivity were found to be independent risk factors on survival. Conclusion: Our study showing that GPC3 overexpression is a poor prognostic factor in HCC.GLP3 positivity were found to be independent risk factors on survival.

European Journal of Gastroenterology & Hepatology

Objectives Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increa... more Objectives Hepatocellular carcinoma (HCC) is a cancer with a poor prognosis, its incidence increases with age. The risk of developing HCC is highest in the seventh decade. In this study, we aimed to determine the clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC in the elderly and young populations. Methods All patients aged ≥18 years who were diagnosed histologically between 2016 and 2020 were included in the study. Patients were divided into two groups: <70 years and ≥70 years. The clinicopathological differences, treatment choices, survival times, and effective prognostic factors of HCC were compared in the elderly and young populations. Results A total of 407 patients were evaluated. There were 164 patients (40.3%) in the geriatric age group. There was no significant difference in the female/male ratio, the laboratory values, survival time between the two groups. There was no significant difference between the two grou...

Digestive Endoscopy, Dec 27, 2011

A 65-year-old man was admitted to hospital with right upper quadrant pain, fever and jaundice. Ph... more A 65-year-old man was admitted to hospital with right upper quadrant pain, fever and jaundice. Physical examination was consistent with cholangitis. Laboratory studies revealed leukocytosis, elevated liver enzymes, and hyperbilirubinemia; and ultrasonographic examination revealed dilated bile ducts with stone images in it. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and during the procedure, the papilla was not observed in the normal location; indeed it was located in the deformed bulb of the duodenum just before a partial apical stricture. Due to the deformity in this region, positioning of the papilla with a side-viewing duodenoscope was not possible for intervention. A normal gastroscope (Olympus GIF-H-260, Olympus Optical, Tokyo, Japan) was inserted. An excellent view and position for the procedure was achieved (Fig. 1). The bile duct was cannulated, the papilla was dilated with a dilation balloon, and stone and bile sludge extraction with a stoneextraction balloon was carried out (Fig. 2). The patient was discharged the day after the procedure without any complications. Ectopic opening of the common bile duct (CBD) into the bulb of the duodenum has been reported in 0.43% of patients undergoing ERCP. It is reported that the ectopic opening of the CBD in the duodenal bulb was not an incidental finding, but a pathological condition that can be associated with recurrent or intractable duodenal ulcer, recurrent biliary pain, choledocholithiasis or acute cholangitis. Deformity and stenosis in the bulb can be as high as 49% in these patients and cannulation of CBD may not be possible due to this deformity in some of them. In some of these patients we recommend that the procedure is carried out with a gastroscope, as in our case, which may supply a better working position. Balloon dilation instead of sphincterotomy is preferred due to the increased risk of perforation in these patients.

Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of mu... more Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of multiple sclerosis (MS). However, both drugs rarely cause liver toxicity (1, 2). Herein, we present a patient with MS who developed severe hepatotoxicity while using interferon after pulse methylprednisolone therapy. A 28-year-old woman was visited in the Gastroenterology Outpatient Clinic because of elevated liver enzymes after intake of interferon-β 1b for attack of MS on May 2007. In her past medical history, she was diagnosed with MS in August 2006. After the diagnosis, she received 1000 mg per day intravenous methylprednisolone for seven consecutive days. During the steroid therapy, her liver function tests were normal. In October 2006, she had a second attack of MS and received another course of 1000 mg per day methylprednisolone therapy. However, on the third day of the treatment (November 2006), her liver enzymes elevated. She developed her third attack in March 2007 when she received 1000 mg per day methylprednisolone for five consecutive days. She began to use 0.3 mg interferon-β 1b (Betaferon) every other day, at the beginning of April 2007 (two weeks after methylprednisolone therapy). The baseline liver function tests were normal. One month after beginning of interferon-β 1b, serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased. The overall follow-up course of the patient is summarized in Table 1. On admission to the Gastroenterology Ward, she had no complaints and her physical examination was normal. She denied abuse of illicit drugs or alcohol. She had no history of liver disease or drug reaction. She was not taking any concomitant drugs, vitamins or herbal supplements. Complete blood count, prothrombin time and biochemical tests other than liver enzymes were within normal limits. Viral (hepatitis serology and atypical viral serologies including Epstein-Barr virus [EBV], cytomegalovirus [CMV] and herpes simplex virus [HSV]) and autoimmune serologies were all negative. The serum level of immunoglobulin G (IgG), ceruloplasmin and |α |1-antitrypsin, iron profile, thyroid function tests were also normal. Hepatobiliary ultrasonography was normal too. Interferon-β 1b was discontinued. Her liver enzymes continued to rise and peaked on the 17 day after cessation of the therapy. She had an ALT of 875 (Nl: <41) IU/L, AST of 501 (Nl: <40) IU/L, |γ|-glutamyl transferase (GGT) of 111 (Nl: <55) U/L, total bilirubin of 4.66 (Nl: < 1.1) mg/dL, direct bilirubin of 3 (Nl: <0.3) mg/dL and prothrombin time of 21 (Nl: 10-14) sec. Liver biopsy performed showed moderate lobular inflammation, centrilobular confluent necrosis, bridging necrosis accompanied with porto-portal and porto-central fibrosis. After some supportive management, prothrombin time returned to normal

Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of mu... more Methylprednisolone and interferon-|β| 1b are the two drugs frequently used in the treatment of multiple sclerosis (MS). However, both drugs rarely cause liver toxicity (1, 2). Herein, we present a patient with MS who developed severe hepatotoxicity while using interferon after pulse methylprednisolone therapy. A 28-year-old woman was visited in the Gastroenterology Outpatient Clinic because of elevated liver enzymes after intake of interferon-β 1b for attack of MS on May 2007. In her past medical history, she was diagnosed with MS in August 2006. After the diagnosis, she received 1000 mg per day intravenous methylprednisolone for seven consecutive days. During the steroid therapy, her liver function tests were normal. In October 2006, she had a second attack of MS and received another course of 1000 mg per day methylprednisolone therapy. However, on the third day of the treatment (November 2006), her liver enzymes elevated. She developed her third attack in March 2007 when she recei...

The Turkish journal of gastroenterology, Dec 1, 2011

1. Turk J Gastroenterol. 2011 Dec;22(6):651-2. Giant fibroepithelial polyp of the anus. Yilmaz B,... more 1. Turk J Gastroenterol. 2011 Dec;22(6):651-2. Giant fibroepithelial polyp of the anus. Yilmaz B, Coban S, Usküdar O, Unverdı H, Aktaş B, Yüksel O. Dışkapı Yıldırım Beyazıt Educational and Research Hospital, Department of Gastroenterology, Ankara, Turkey. ...

Canadian journal of gastroenterology & hepatology, 2018

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of t... more Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD <5cm to 56.4% with tumors of MTD >10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared...

Acta gastro- …, 2008

... Giant hepatic paraganglioma succesfuly treated with embolisation. Auteur(s) / Author(s). USKÜ... more ... Giant hepatic paraganglioma succesfuly treated with embolisation. Auteur(s) / Author(s). USKÜDAR Oguz (1) ; ZENGIN Neslihan (2) ; KÖKLÜ Seyfettin (1) ; YÜKSEL Ilhami (1) ; BASAR Omer (1) ; Affiliation(s) du ou des auteurs / Author(s) Affiliation(s). ...

Endoscopy, 2009

Fig. 1 A mass on the left parotid gland. UCTN-Unusual cases and technical notes E53 Gültuna S et ... more Fig. 1 A mass on the left parotid gland. UCTN-Unusual cases and technical notes E53 Gültuna S et al. Transient parotitis after conscious sedation for endoscopy … Endoscopy 2009; 41: E53 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and ... more Purpose: Hepatocellular carcinoma (HCC) is the seventh most common cancer all over the world and is second in cancer-related deaths. . In HCC, whose prognosis is still not good despite current treatments, there is a need for prognostic markers as well as early diagnosis. Glypican (GPC)-3 has been proposed as a potential serologic and histochemical marker specific to HCC. The aim of this study was to determine the relationship between GPC3 overexpression and HCC prognosis and clinicomorphologic features.Patients and methods: In total 152 patients patients who were diagnosed as a result of hepatectomy, lobectomy, or liver transplantation were enrolled. The patients were divided into two groups as GPC3-positive (>10%) and GPC3-negative (<10%). The demographic data of the patients ,tumor characteristics , survival times were recorded.Results: Survival was significantly lower in the GPC3+ group. In the multivariate analysis, hepatitis C, AFP, tumor number, tumor focality, portal ve...

Video Journal and Encyclopedia of GI Endoscopy, 2013

Fasciola is 15-30-mm long, flat, liver trematode that is endemic in sheep-raising regions. Consum... more Fasciola is 15-30-mm long, flat, liver trematode that is endemic in sheep-raising regions. Consumption of raw aquatic vegetables such as watercress contaminated with metacercariae is the main cause of infection. The disease has three stages: an acute invasive, chronic latent, and chronic obstructive phase. Clinical and laboratory findings are related to the stage of the disease. Ultrasound can detect parasites within the bile duct as hyperechoic motile objects without shadow at the chronic obstructive phase. Biliary sphincterotomy and extraction of Fasciola flukes by balloon or basket are very effective and safe interventions which provide a fast symptomatic response. This article is part of an expert video encyclopedia.

Journal of Translational Science, 2018

Introduction: Several markers of systemic inflammation, including blood C-reactive protein, plate... more Introduction: Several markers of systemic inflammation, including blood C-reactive protein, platelet lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) have been identified as independent prognosticators for hepatocellular carcinoma (HCC). Methods: To attempt to understand the significance of these markers, they were examined in relation to 4 tumour parameters, namely maximum tumour diameter (MTD), tumour multifocality, portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels. Results: Using linear and logistic regression models, we found that C-reactive protein and PLR on single variables, were statistically significantly related to the tumour parameters. In a logistic regression final model, CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index significantly related to MTD and AFP. Results of the area under the receiver operating characteristic curves (ROC), showed that the areas for PLR and CRP were statistically significant for high versus low MTD and for presence versus absence of PVT. CRP alone was significant for high versus low AFP. Conclusions: These analyses suggest that the prognostic usefulness of the inflammatory markers PLR and CRP (but not NLR) may be due to their reflection of parameter values for tumour growth and invasiveness.

Platelets, 2011

To the Editor Thrombocytopenia is a frequent feature in patients with liver cirrhosis. It has bee... more To the Editor Thrombocytopenia is a frequent feature in patients with liver cirrhosis. It has been mainly attributed to the sequestration of platelets by an enlarged spleen due to portal hypertension which is named as ‘‘hypersplenism’’ [1]. Mechanisms other than hypersplenism such as reduced thrombopoetin or bone marrow suppression also contribute this thrombocytopenia [2]. A 55 year old male was admitted to the hospital with a diagnosis of severe thrombocytopenia. Platelet counts were 4500 m/l and peripheral smear was compatible with it. Patient’s history revealed right nephrectomy twelve years ago due to chronic pyelonephritis and blood transfusion. HCV hepatitis was diagnosed 8 years ago and liver biopsy showed chronic hepatitis with hepatitis activity index 9 and fibrosis score stage 3–4. Patient was treated with ribavirin plus interferon for 6 months but viral eradication could not be achieved. Physical examination revealed splenomegaly without other signs of decompansation. Neither petechiael nor purpuric lesions were observed. Laboratory studies revealed AST: 104 U/l, ALT: 60 U/l, albumin: 3.2 g/dl, creatinine: 0.8 mg, INR: 1.2, WBC: 4500, hemoglobin: 12.2 g/dl. HCV viral load was 816 000 IU/ml with genotype 1. ANA was negative but antithrombocyte antibody was positive. Bone marrow aspiration and biopsy showed increased number of megacaryocytes. (Figure 1) Thrombocytes were filtered in aphaeresis unit and thrombocyte HCV viral load was measured as 5 560 000 IU/Ml which was seven times higher than serum level. Patient did not respond to 14 days steroid (1 mg/kg) treatment and intravenous immunoglobulin (1 g/kg, for 2 days) was administered. Ten days after immunoglobulin administration platelet counts increased up to 300 000/ml. (Figure 2) The degree of thrombocytopenia in HCV patients appears to be significantly greater than other forms of liver disease [3]. Other than aforementioned mechanisms hepatitis C virus can also cause thrombocytopenia as a result of bone marrow suppression resulting from HCV itself or aberrations of the immune system

Digestive Endoscopy, 2012

Dear Editor, The diagnosis of acute appendicitis is frequently based on clinical criteria. Howeve... more Dear Editor, The diagnosis of acute appendicitis is frequently based on clinical criteria. However, to minimize the rate of negative appendectomies (determined as high as 20% in some risky populations, such as young women, and especially with a history of irritable bowel syndrome), ultrasonography and/or computed tomography are the main appropriate imaging modalities. Even with the high specificity and sensitivity rates of these methods, colonoscopic procedures are also reported as a diagnostic examination for acute appendicitis, mostly for delayed or atypical presentations. Here, we report two patients with a diagnosis of acute appendicitis by colonoscopy. The first case was a 26 year-old-woman admitted to our unit with abdominal discomfort for 1 week. Her medical history was negative except for dysmenorrhea, physical examination revealed only mild inguinal tenderness, and laboratory results showed mild leucocytosis. She also had a family history of colon cancer in her first-degree relatives at an early age. Colonoscopy showed a small polyp-like bulging of the appendix with erythematous mucosa and also pus flowing from the internal orifice (Fig. 1). According to the endoscopic view, she underwent appendectomy in view of suspicion of acute appendicitis. A swollen appendix was seen during the surgical operation, so appendectomy was carried out. Histology was consistent with suppurative appendicitis showing a mixed inflammatory infiltrate involving the entire wall of the appendix and focal ulceration of the surface. The second case, a 42-year-old man was referred to our clinic with abdominal computed tomography showing wall thickening at the terminal ileal level. Patients’ history revealed intermittent abdominal pain and discomfort in the right lower abdomen. His physical examination was unremarkable and laboratory results were within normal limits. Colonoscopy carried out to rule out inflammatory bowel disease showed a bulging polypoid hyperemic lesion at the appendiceal orifice (Fig. 2). Subsequently, the patient underwent a right hemicolectomy with a diagnosis of cecal mass lesion. Histological findings revealed xantogranulomatous inflammation consistent with plastrone appendicitis. Some of the patients had the diagnosis of acute appendicitis based on surgical operation and had a history of previous attack, or pain for 2–3 weeks.All the cases ultimately had to go to appendectomy, and in cases of delayed diagnosis, the risk of mortality and morbidity will increase. Therefore, the physicians faced pressure to get an accurate diagnosis as soon as possible. In conclusion, colonoscopic procedure should be an alternative diagnostic modality in patients with atypical presentation of abdominal pain and discomfort, and may be useful for patients with non-diagnostic imaging studies.

The Turkish Journal of Gastroenterology, 2011

Acta gastro-enterologica Belgica

Aim. To present follow-up results of our chronic hepatitis patients infected with HDV treated wit... more Aim. To present follow-up results of our chronic hepatitis patients infected with HDV treated with subcutaneous interferon (IFN). Method. A total of 24 patients, 21 males and 3 females with HBsAg (+), AntiHBc IgM (-), antibody against hepatitis D virus (anti HDV) and/or HDV RNA (+) and with above normal values for serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), who had no contraindications for treatment and had suitable histological activity index (HAI) and fibrosis scores in their liver biopsies were enrolled. Patients treated with three doses of 9-10 MU subcutaneous IFN per week. Serum aminotransferases, HBsAg, antibody against HbsAg (anti HBs), hepatitis B e antigen (HBeAg), antibody against HBeAg (anti HBe), HBV DNA, anti HDV and/or HDV RNA levels were determined before, during and after treatment. Results. Nine patients (37.5%) stopped treatment in an early phase. In 3 patients (12.5%), treatment was discontinued due to severe side effects. In the pos...