[Contribution to determination of hepatitis C virus genotypes in Black Sea region: data from single high volume center in Zonguldak, Turkey]. / Karadeniz Bölgesi hepatit C virus genotip belirlenmesine katki: Yüksek hasta kapasiteli tek merkez verileri, Zonguldak.

We've read with great interest the article entitled "Determination of hepatitis C virus genotypes among hepatitis C patients in Eastern Black Sea Region, Turkey" by Buruk et al. published in Mikrobiyol Bul 2013; 47(4): 650-7. In that study, the authors described the determination and distribution of hepatitis C virus (HCV) genotypes in Eastern Black Sea Region comprehensively. According to the current information, the determination of HCV genotypes is the most important factor for the management of therapy and virus-related complications, such as chirrhosis and hepatocellular carcinoma. The distribution of HCV genotypes varies geographically throughout the world. Therefore every country and even each region within the country should know the distribution of HCV genotypes to determine the appropriate treatment strategy. Herein we would like to contribute the data about distribution of HCV genotypes in whole Black Sea Region by presenting our current results obtained from Zonguldak province, where maximum number of chronic hepatit C patients have already been identified in Eastern Black Sea Region. A total of 53 chronic hepatitis C patients (26 female, 27 male; mean age: 57.1 ± 14.3, age range: 21-82 years) who were admitted to Zonguldak Ataturk State Hospital between January 2012-December 2013 were evaluated. Genotype analysis was performed by RealTime HCV Genotype II (Abbott Molecular, ABD) system. Genotype-1 was found to be the most frequently detected type with a rate of 96.2% (51/53). The prevalences of genotype-2 (1/53) and genotype-4 (1/53) were same, with a rate of 1.9%, in our study. Subtyping of genotype-1 strains yielded 52.9% (27/51) genotype-1b, 3.9% genotype-1a (2/51) and 47% untypeable genotype-1 (24/51). The present study was the second study from the Western Black Sea Region in our country, regarding HCV genotypes. In conclusion, considering entire Black Sea Region, genotype-1 is the most common genotype (96.2%), and 1b (52.9%) is the most common subtype, in parallel to the data reported from the other regions of Turkey.

Differential diagnosis of Crohn's disease using antibodies to glycoprotein 2 and Saccharomyces cerevisiae.

BACKGROUND/AIMS: Glycoprotein 2 (GP2), the major autoantigen of Crohn's disease (CD)-specific pancreatic autoantibodies, is reportedly correlated with several characteristics of CD. We investigated this serological marker in Turkish patients with CD and assessed its utility in combination with anti-Saccharomyces cerevisiae antibodies (ASCAs) for differential diagnosis of CD. MATERIALS AND METHODS: A total of 60 patients with CD, 62 patients with ulcerative colitis (UC), and 46 healthy controls with a definite diagnosis who were similar in age and sex were enrolled in the study conducted from November 2011 to October 2012. ASCA and anti-GP2 levels were measured using commercially available kits. RESULTS: Anti-GP2 IgA and IgG levels were higher in patients with CD (25%) than in those with UC (5%) and controls (2%). The seroprevalence of anti-GP2 IgA was markedly higher than that of IgG in patients with CD in contrast to previous studies. The specificity and positive predictive value of seropositivity for both ASCA and anti-GP2 were 100%. ASCA IgA seropositivity was correlated with a complicated disease course and a history of surgery. There was no correlation between anti-GP2 seropositivity and disease location, disease behavior, or a history of surgery. CONCLUSION: The combination of ASCA and anti-GP2 may enable differentiation of CD from UC. As ASCA seropositivity is associated with a more complicated disease course, patients seropositive for ASCA at the initial diagnosis should undergo more intense therapy.

Newly Diagnosed Crohn's Disease in Patient with Familial Mediterranean Fever.

Chronic abdominal pain sometimes constitute a major challenge, specially when a patient has two diseases with dominant features of abdominal pain in both. At this point, clinicians face a daunting task both in diagnosing and treating an individual's chronic abdominal pain. Similarly, familial Mediterranean fever disease and Crohn's disease have the same clinical features in terms of chronic abdominal pain, and inflammatory properties of these diseases. The association of familial Mediterranean fever disease and Crohn's disease is very rare and may lead to a remarkable challenge in both diagnosis and treatment. Here, we report a young man with FMF disease presented with extraordinary and intolerable abdominal pain relieved only by excessive narcotic analgesics. The presented case was diagnosed with CD and successfully treated with anti-TNF (tumor necrosis factor) due to steroid refractory.

Analysis of risk factors associated with complications of colonic stenting for malignant obstruction.

Self expanding metalic stent (SEMS) application can cause serious problems up to one third of the patients and some studies reported negative effect of SEMSs on survival in patients with malignancy. The SEMS type especially the rigid one like Wall-stent rather than more flexible type Ultraflex was also reported to have bad impact on the risk of perforation we believe that stent based management protocol for patients with non-perforating left sided obstructing colorectal cancer is a complex method that needs qualified medical and technical team.

Endoscopic submucosal dissection for colorectal laterally spreading tumors.

BACKGROUND/AIMS: Colorectal laterally spreading tumors are superficial tumors classified into two groups as granular (G-laterally spreading tumor) and non-granular (non-granular-laterally spreading tumor) types. In this study, we aimed to investigate the efficacy and feasibility of endoscopic submucosal dissection in the treatment of laterally spreading tumors. MATERIALS AND METHODS: Forty-four laterally spreading tumors in 40 patients were treated with endoscopic submucosal dissection at a tertiary referral hospital. Patient data were collected retrospectively. In this study, we evaluated tumor size, macroscopic type, lesion location, histology, curative resection, and complications. RESULTS: Of the 44 laterally spreading tumors excised by endoscopic submucosal dissection, 29 (65.9%) were G-laterally spreading tumor and 15 (34.1%) were non-granular-laterally spreading tumor. Most of the non-granular-laterally spreading tumors were localized in the right colon, while most G-laterally spreading tumors were localized in the left colon (p<0.001). There was also no difference between G-laterally spreading tumors (6/29) and non-granular-laterally spreading tumors (2/15) with regard to exhibiting malignant features (p=0.69). Although median size (40 mm vs. 27.5 mm) and procedure time (115 minutes vs. 60 minutes) for G-laterally spreading tumors were bigger and longer respectively, procedure time per cm2 was not different (8.9 minutes vs. 8.2 minutes) between the two groups. Curative resection rates for laterally spreading tumors were quite high (95.5%), while en bloc resection rates were low (77.3%). The rates of endoscopic submucosal dissection-related complications such as perforation, major and minor bleeding were low (4.5%, 2.3%, 6.8%, respectively). CONCLUSION: Endoscopic submucosal dissection is an effective and safe therapeutic option with high curative rates for early-stage malignant and pre-malignant laterally spreading tumors not having an absolute indication for surgery, regardless of the lesion type and size.

Nonresponsive celiac disease due to Strongyloides stercoralis infestation.

Celiac disease (CD) is treated by eliminating all gluten from the diet. A 49-year-old man with CD was admitted to our clinic with complaints of recurrent diarrhea and abdominal pain despite strict adherence to a gluten-free diet. The duodenum was seen to be edematous on gastroduodenoscopic examination. Histological examination of the biopsy specimen taken from the duodenum showed multiple round shaped Strongyloides stercoralis (S. stercoralis) larvae within the crypts. He was successfully treated with albendazole. This case emphasizes the importance of duodenal biopsy in CD. To our knowledge, this is the first case in the literature showing CD and S. stercoralis together.

Severe jaundice due to coexistence of Dubin-Johnson syndrome and hereditary spherocytosis: a case report.

Dubin-Johnson syndrome is a chronic, benign, intermittent jaundice, mostly of conjugated hyperbilirubinemia. The level of bilirubin is not expected to be more than 20 mg/dl in this syndrome. In this article, we report a patient who was evaluated for hyperbilirubinemia and liver function test abnormalities and diagnosed with Dubin-Johnson syndrome coexisting with hereditary spherocytosis. We suggest that other diseases should be investigated if patients with Dubin-Johnson syndrome present with severe hyperbilirubinemia. Dubin-Johnson syndrome accompanied by hemolytic diseases might also have high coproporphyrin levels (as in Rotor's syndrome) than expected in pure Dubin-Johnson syndrome.

Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers.

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.