Predictive Value of Preoperative 18 Fludeoxyglucose Positron Emission Tomography-Computed Tomography for Survival in Liver Transplantation Due to Hepatocellular Cancer.

BACKGROUND: We aimed to study the predictive value of preoperative perform [18F] Fludeoxyglucose positron emission tomography-computed tomography ([18] FDG PET-CT) for survival in liver transplantation due to hepatocellular cancer. METHODS: Ninety-six patients who underwent liver transplantation for hepatocellular cancer (HCC) after preoperative PET-CT evaluation were examined for the study. All patients' ages, genders, body mass index, blood groups, Child-Pugh and Model for End-Stage Liver Disease scores, etiologies, median Alpha Fetoprotein values, Milan Criteria and T stages, grades, macrovascular and microvascular invasions, multicentricities, maximum and total tumor sizes, tumor number findings in explant specimens, and recurrence rates were analyzed statistically. RESULTS: Statistically, microvascular (P = .002) and macrovascular invasions (P = .034) were observed more frequently in patients who are PET-CT (+) compared with patients who are PET-CT (-). PET-CT positivity was associated with shortened disease-free survival (DFS) statistically (P = .004). CONCLUSION: Positron emission tomography-CT positivity may be important for predicting prognostic markers such as DFS and vascular invasion in the preoperative evaluation. Before transplantation, PET-CT should be applied to all patients with HCC.

Factor 5 and Factor 2 heterozygous positivity and complications in living donor liver transplant donors.

OBJECTIVE: Factor 2 and Factor 5 mutations are among the most common procoagulant genetic disorders and are routinely evaluated in donor preparation. Homozygous mutations are contraindicated for surgery, but heterozygous mutations cannot be said to be an impediment. We aimed to investigate the effect of heterozygous gene mutation of F2 and/or F5 on complications. METHODS: In our study, 210 living liver donors were examined. The available data of Factor 2 and 5 heterozygous positive donors were evaluated in terms of 21 donor patients and 30 liver recipients. The heterozygous positive group and the control group were statistically compared in terms of age, gender, length of hospital stay, post-operative deep vein thrombosis, pulmonary embolism, portal vein thrombosis, bile duct stenosis and bile leakage complications, lung infection and atelectasis, and wound infection. In addition, these patients were statistically compared in terms of laboratory tests. In addition, complications in recipients implanted with mutant grafts were evaluated statistically and numerically. RESULTS: Hospital staying was longer statistically in the donor group with heterozygous mutations than in the control group. Hemoglobin and albumin blood levels were lower (p=0.031, p=0.016); INR and ALT levels were higher (p=0.005, p=0.047) statistically in the control group than in the donor group with heterozygous mutations. There was no statistically significant difference between heterozygous mutant groups in terms of biliary tract complications and hepatic vessel thrombosis in recipients. CONCLUSION: Considering the longer hospital stay in the presence of these mutations, the increased need for treatment in this process and the close follow-up of liver functions should be considered.

Incidental combined hepatocellular-cholangiocarcinoma in liver transplant patients: Does it have a worse prognosis?

Background and Aim: Combined hepatocellular-cholangiocarcinoma (CHC) requires attention clinically and pathologically after liver transplantation (LT) because of its unique biology, difficulties in diagnosis, and being rare. We aimed to present our single-center experience for this incidental combined tumor. It is aimed to present our single-center experience for this incidental combined tumor. Materials and Methods: Seventeen patients with CHC were included in the study. There were 260 hepatocellular carcinoma (HCC) patients determined as the control group. Patients were evaluated for demographic, etiological, pathological features, and survival. Results: Macrovascular and microvascular invasion levels were significantly higher in the CHC group (p<0.05). P53, CK19, and CK7 levels were significantly higher in the CHC group (p<0.05). Hepatocyte-specific antigen level was significantly higher in the HCC group. The mean overall survival was significantly higher in the HCC group (p<0.05). Conclusion: Even though CHC is a rare liver tumor, it has features that need to be clarified regarding both survival and tumor biology. Investigating prognostic factors, especially in terms of survival and recurrence, will be very beneficial to identify candidates who will benefit from LT and be included in the indications for LT for CHC. This study evaluated the outcomes of patients showing combined HCC-intrahepatic cholangiocarcinoma in explant pathology.

A Single-Center's Early Surgical Outcomes of Living Donor Liver Transplantation.

BACKGROUND: Living donor liver transplantation (LDLT) has become an increasingly common surgical option because the number of cadaveric donors is insufficient to fulfill the organ needs of patients facing end-stage cirrhosis. Many centers are investigating different surgical techniques to achieve lower complication rates. We aimed to examine our complication rates in light of demographic data, graft data, and perioperative findings as a single-center experience. METHODS: The study included one hundred and three patients who underwent LDLT for end-stage liver cirrhosis. Demographic data; sex; age; blood group; Model for End-Stage Liver Disease score; Child score; etiology; liver side; graft-to-recipient weight ratio; hepatic artery, portal vein, and bile anastomosis type rates; anhepatic phase; cold ischemia time; operation time; and blood product transfusion rates were analyzed. Biliary complications in patients with single or multiple biliary anastomoses, right or left liver transplants, and with or without hepatic artery thrombosis were analyzed statistically. RESULTS: There was no significant difference in biliary complications between patients who underwent single or multiple bile anastomosis (P = .231) or patients receiving right lobe and left lobe transplants (P = .315). Although there was no statistically significant difference in the rate of portal vein thrombosis between the regular and reconstructed portal vein anastomosis groups (P = .693), the postoperative portal vein thrombosis rate was statistically higher in patients with left lobe transplants (P = .044). CONCLUSIONS: Vascular and biliary complication rates can be reduced with increasing experience.

Evaluation of Predisposing Metabolic Risk Factors for Portopulmonary Hypertension in Patients with NASH Cirrhosis.

PURPOSE: Metabolic parameters are important for the development of portopulmonary hypertension (PoPH) during nonalcoholic steatohepatitis (NASH)-associated cirrhosis. This study evaluated patients with NASH-associated cirrhosis to determine metabolic risk factors for portopulmonary hypertension. PATIENTS AND METHODS: Data on 171 patients (120 men and 51 women) with NASH-associated cirrhosis who were seen in Florence Nightingale Hospital's gastroenterology Clinic from 2009 to 2018 was obtained from the Hospital database. A pulmonary artery systolic pressure >35 mmHg was defined as PH (pulmonary hypertension) according to standard transthoracic echocardiography. Portal hypertension was diagnosed from clinical symptoms and dilated portal veins shown by abdominal ultrasound or computed tomography (CT). Pulmonary patients with portal hypertension were diagnosed with portopulmonary hypertension (PoPH). RESULTS: A total of 171 patients with NASH-associated cirrhosis were included in this study. Of these, 43 patients had PoPH. These patients had increased TSH (p=0.004), bilirubin (p=0.023) and triglyceride (p=0.048) levels, higher MELD scores (p=0.018) and decreased hemoglobin (p=0.05). MELD score and hemoglobin, total bilirubin, TSH, and triglyceride levels were all included in a multivariate logistic regression model and TSH levels were independently associated with increased risk of PoPH. CONCLUSION: Increased TSH is an independent risk factor for PoPH.

Does the FT3-to-FT4 ratio easily predict the progression of NAFLD and NASH cirrhosis?

BACKGROUND: Factors causing progression from nonalcoholic fatty liver to nonalcoholic steatohepatitis (NASH) and liver cirrhosis remain relatively unknown. We aimed to evaluate the power and effectiveness of the free triiodothyronine (FT3)-to-free thyroxine (FT4) ratio to predict non-alcoholic fatty liver disease (NAFLD)/liver fibrosis and NASH cirrhosis severity. METHODS: Patients (n = 436) with NASH-associated liver cirrhosis (n = 68), patients with liver biopsy-proven NAFLD (n = 226), or healthy participants (n = 142) were enrolled between January 2010 and January 2020. The aspartate aminotransferase-to-thrombocyte ratio (APRI), NAFLD fibrosis score, albumin-bilirubin score (ALBI), aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio, FT3-to-FT4 ratio, and Fibrosis-4 (FIB-4) were calculated and evaluated. RESULTS: All parameters were significantly higher in NASH cirrhosis than in the healthy group. Body mass index, ALT, fasting insulin, homeostatic model assessment for insulin resistance, and triglyceride levels were significantly higher in liver biopsy-proven NAFLD than in the healthy group. The APRI, NAFLD fibrosis score, ALBI, AST-to-ALT ratio, FT3-to-FT4 ratio, and FIB-4 were significantly higher in the NASH cirrhosis group than in the healthy group. In patients with biopsy-proven NAFLD, the FT3-to-FT4 ratio was significantly lower than in the healthy group. CONCLUSION: The FT3-to-FT4 ratio is an effective and useful indicator to predict NAFLD/liver fibrosis and NASH cirrhosis severity.

The comparison of pancreatic and hepatic steatosis in healthy liver donor candidates.

The aim of this study was to investigate the relationship between nonalcoholic fatty liver disease (NAFLD) and pancreatic steatosis (PS) in patients with biopsy-proven NAFLD. 228 patients with biopsy-proven NAFLD patients who admitted to the Faculty of Medicine of Demiroglu Bilim University between 2004 and 2019 were included in the study. Demographic, laboratory, histological and radiological findings of the patients were recorded retrospectively. Hepatosteatosis (HS) levels were measured by both CT and biopsy, while PS levels were measured by 3 different CT-based techniques. 89 (39%) of the patients were female and 139 (61%) were male. The mean body mass index (BMI) was 27.2 ± 4.0. Biochemical parameters were within normal limits. Liver biopsy showed a significant correlation with HS grade on CT scan (p < 0.001). When CT findings were compared, a significant correlation was found between PS and HS (p < 0.05), but there was no correlation between the HS level in biopsy and the pancreatic adiposity on CT (p > 0.05). Our study was the first to compare biopsy-proven NAFLD and PS, and no correlation was found between biopsy-proven NAFLD and PS.

Can hypothyroidism be a protective factor for hepatocellular carcinoma in cirrhosis?

Despite many studies, the molecular mechanisms of hepatocellular carcinoma (HCC) development remain unclear. Thyroid hormone (TH) levels may vary in many chronic diseases including cirrhosis. The aim of this study was to evaluate TH status in patients with cirrhosis and HCC and to investigate the relationship between THs and HCC development.Five hundred seventy-seven patients with cirrhosis who applied to Demiroglu Bilim University, Faculty of Medicine, Gastroenterology Department between 2004 and 2019 were included the study. Three hundred sixty-seven patients who applied to Internal Medicine Unit for general health check-up were included in the study as healthy control group. Demographic, laboratory, and imaging findings of study groups were retrospectively reviewed and recorded from hospital information system.In the cirrhosis group, 252 patients had HCC (43.67%), and 325 patients had non-HCC cirrhosis (56.33%). Free thyroxine (FT4) levels were higher in the control group than in the cirrhotic group but there was no significant difference (P = .501). Thyroid-stimulating hormone (TSH) and FT4 levels were similar between groups, while free triiodothyronine (FT3) levels were significantly different between HCC group, non-HCC cirrhosis group, and control group (P = .299 for TSH, P = .263 for FT4, P < .001 for FT3). FT3 levels were significantly higher in HCC group than non-HCC cirrhosis group, but significantly lower than control group (P < .05).Our study confirmed the presence of hypothyroidism in cirrhosis patients and clearly demonstrated a strong relationship between FT3 levels and HCC development.

Evaluation of Plateletcrit and Platelet Distribution Width in Patients with Non-Alcoholic Fatty Liver Disease: A Retrospective Chart Review Study.

BACKGROUND Platelets are considered to be essential in proinflammatory environments, including atherosclerosis. The degree of platelet activation has been demonstrated to be correlated with plateletcrit and platelet distribution width. The main purpose of this study was to assess the relationship between plateletcrit (PCT), platelet distribution, and the degree of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS We enrolled 225 biopsy-proven NAFLD patients and 142 control subjects without NAFLD. NAFLD patients were separated into 2 groups according to percentage of steatosis. Demographic and clinical data were collected retrospectively. RESULTS PCT level was significantly higher in NAFLD group I and group II than in the control group. PCT was higher in the NAFLD groups than in the control group. However, there was no difference according to PCT and PDW levels between NAFLD groups. CONCLUSIONS In this study, a relationship was found between PCT and hepatosteatosis, but no relationship was found with PDW. PCT might be a useful biomarker for early detection of steatohepatitis in patients with nan-alcoholic fatty liver disease.

Prognostic role of ABO blood group and Rhesus factor in cirrhotic patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common types of cancer worldwide. There are many factors in the etiology of HCC such as hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol, obesity, smoking and aflatoxin. Many types of cancer are assumed to be associated with ABO blood group and Rhesus factor (RH). In this study we aimed to evaluate the relationship between tumor characteristics and overall survival (OS), ABO blood group and RH factor in patients with HCC. A total of 507 patients with chronic liver disease (252 patients with HCC and 255 patients without HCC) were included in the study. All demographic, clinic and laboratory (biochemical parameters and blood type) features were collected retrospectively. The mean age of the patients was 54.50 ± 9.30. There was no significant difference in both ABO groups and RH factors between the two groups. We found that vascular invasion rate of the tumor was higher in the B blood group and multicentric localization of tumor was significantly higer in patients with positive RH but there was no difference between OS in ABO and RH blood groups. In addition, the tumor was less multicentric in the AB blood group. Blood groups and RH factor can be used to predict the prognosis in cirrhotic patients with HCC.

Relationship Between Serum Uric Acid Levels and Nonalcoholic Fatty Liver Disease in Non-Obese Patients.

Background and objectives: Nonalcoholic fatty liver disease (NAFLD) is associated with multiple factors such as hypertension, diabetes, dyslipidemia, obesity, and hyperuricemia. We aim to investigate the relationship between uric acid and NAFLD in a non-obese and young population. Materials and Methods: This study was performed in January 2010-2019 with a group of 367 (225 patients in the NAFLD group and 142 in the control group) patients with liver biopsy-proven NAFLD or no NAFLD. Patients with NAFLD were classified according to the percentage of steatosis as follows, group I had 1-20% and group II >20%. Demographic, clinical, and laboratory (biochemical parameters) features were collected retrospectively. Results: The mean body mass index (BMI) and age of the patients were 26.41 ± 3.42 and 32.27 ± 8.85, respectively. The BMI, homeostatic model of assessment (HOMA-IR), and uric acid (UA) values of the NAFLD group were found to be significantly higher than those of the controls. A positive correlation was found between the NAFLD stage and UA. The following factors were independently associated with NAFLD: BMI, HOMA-IR, and UA. In addition, the cut-off value of UA was 4.75 mg/dl with a sensitivity of 45.8% and a specificity of 80.3%. Conclusions: UA is a simple, non-invasive, cheap, and useful marker that may be used to predict steatosis in patients with NAFLD.

Assessment of Mean Platelet Volume in Patients with AA Amyloidosis and AA Amyloidosis Secondary to Familial Mediterranean Fever: A Retrospective Chart - Review Study.

BACKGROUND Amyloidosis is a protein-misfolding disease characterized by the deposition of aggregated proteins in the form of abnormal fibrils that disrupt tissue structure, ultimately causing disease. Amyloidosis is very frequent in untreated familial Mediterranean fever (FMF) patients and it is the most important feature that determines the prognosis of FMF disease. The mean platelet volume (MPV) in FMF has been previously studied. However, whether MPV level in FMF patients is lower or higher compared to healthy controls remains a topic of ongoing debate. In this study, we aimed to investigate MPV values and to assess the correlation between MPV and proteinuria in patients with AA amyloidosis and AA amyloidosis secondary to familial Mediterranean fever (AA-FMF) through a retrospective chart-review. MATERIAL AND METHODS This study was carried out on 27 patients with AA amyloidosis, 36 patients with AA amyloidosis secondary to FMF (a total of 63 patients with AA), and 29 healthy controls. There was no statistically significant difference between the AA patients and the control group (p=0.06) or between the AA-FMF group and the control group in terms of MPV values (p=0.12). RESULTS We found a statistically significant negative correlation between MPV and thrombocyte count in all groups (p<0.05 for all groups), but there was no correlation between MPV and proteinuria levels in AA patients (p=0.091). CONCLUSIONS While similar results also exist, these findings are contrary to the majority of previous studies. Therefore, further controlled clinical prospective trials are necessary to address this inconsistency.

Chronic rhinosinusitis, endothelial dysfunction, and atherosclerosis.

BACKGROUND: Chronic inflammation is associated with accelerated atherosclerosis, endothelial dysfunction (ED), and cardiovascular diseases. Because chronic rhinosinusitis (CRS) is an inflammatory disease, it may be associated with the development of ED and accelerated atherosclerosis. OBJECTIVE: To investigate the relationship between CRS and carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) of the brachial artery, and microalbuminuria. MATERIALS AND METHODS: This cross-sectional study included 38 patients with CRS and 29 healthy controls. In addition to measuring spot urine albumin-creatinine ratios, FMD of the brachial artery and CIMT were assessed noninvasively. RESULTS: Patients with CRS had lower FMD scores (p = 0.031), higher CIMT scores (p = 0.005), and a higher urinary albumin-creatinine ratio (p = 0.036) compared with healthy controls. In a multivariate analysis, CIMT and FMD were independently associated with the presence of CRS. However, the relationship between urinary albumin and creatinine, and the presence of CRS was no longer observed. CONCLUSIONS: CRS is associated with ED and atherosclerosis, as indicated by decreased FMD and increased CIMT in patients with CRS. Further studies are necessary to identify the exact pathophysiologic mechanisms responsible for our findings.

An unusual case of peritonitis after vaginal leak in a patient on peritoneal dialysis / Un caso infrecuente de peritonitis tras fuga vaginal en un paciente en diálisis peritoneal

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Renalase: Another puzzle piece between hypertension and simple renal cysts?

BACKGROUND AND AIM: Since renalase is mostly expressed in kidney tubules, simple renal cyst (SRC) originates from the kidney tubules, and both conditions are related to hypertension, it may be possible that SRC is associated with increased renalase levels. Therefore, in the current study we aimed to confirm the relation between renalase and epinephrine levels, the association between SRC and renalase levels and the association between renalase, blood pressure levels and endothelial dysfunction. MATERIALS AND METHODS: We made a cross-sectional study including 75 patients with SRC, and 51 controls were included to the study. Flow-mediated dilatation (FMD) was assessed, and serum renalase and epinephrine levels were determined. RESULTS: Patient with SRC had lower renalase, higher epinephrine and lower FMD levels when compared to patients without SRC (p < 0.05). Log renalase was correlated with log epinephrine (r = -0.302, p = 0.001) and log FMD (r = 0.642, p < 0.0001). There was no correlation between renalase and urine albumin/creatinine ratio and glomerular filtration rate. In univariate analysis, age, glomerular filtration rate, renalase and FMD were associated with the presence of SRC. Multivariate regression analysis of factors which are statistically significant in univariate analysis showed that age and renalase was associated with the presence of SRC. CONCLUSION: We have demonstrated that renalase levels were associated with the presence of SRC and endothelial dysfunction. Further research is necessary to highlight underlying mechanisms.

Hyperuricemia is associated with progression of IgA nephropathy.

BACKGROUND AND AIM: IgA nephropathy (IgAN) is one of the world's most common glomerular diseases. Hyperuricemia was recently defined as risk factor for chronic kidney disease. We aimed to investigate the impact of baseline serum uric acid levels on progression of IgAN. MATERIALS AND METHODS: A total of 93 patients with IgAN were screened. Demographic information and biochemical data were recorded. eGFR (using the CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration formula) was used as renal function marker. Baseline and sixth month eGFR values were calculated. Progression of renal disease was defined as the difference between baseline eGFR and sixth month eGFR (delta eGFR). RESULTS: Mean age of the patients was 40 ± 11 years (60% were males). Baseline mean eGFR was 77.9 ± 30.2 mL/min, and baseline mean serum uric acid was 5.65 ± 1.68 mg/dL. Importantly, baseline serum uric acid levels were found to be associated with the change in eGFR (r = 0.252, p = 0.01). In multivariate analysis (adjusted R(2) = 0.171, p = 0.031), adjusting for age, gender, baseline eGFR, blood pressure, baseline albumin concentration and ACEI and/or ARB use revealed that the baseline serum uric acid levels significantly predicted the change in eGFR. CONCLUSION: Baseline serum uric acid concentration is directly proportional to the rate of decline in renal functions in patients with IgAN. Uric acid-lowering treatments may be beneficial for the prevention of progression of IgAN. However, randomized controlled studies are needed for this purpose.

Synthetic marijuana "K2" induced ITP.

Immune thrombocytopenia (ITP) is a heterogeneous disease which can be primary or secondary due to other conditions such as drugs. CB2 receptors (CB2R) also have a role in the ITP pathogenesis as CB2 receptor gene (CNR2) polymorphisms are associated with chronic immune thrombocytopenia and autoimmune diseases. K2 is synthetic marijuana which acts on cannabinoid receptors that are found on immune cells and thrombocytes. Here, we present a case who presented with ITP secondary to K2 usage and was successfully treated with 1 mg/kg prednisolone. This is the first ITP case in the literature due to K2. It is important in the era of the new drugs development of the CB2R mimetics.