Biomedical subjects

Ersan Ozaslan

Publications and source records attributed to Ersan Ozaslan.

11 recordsLinked to original sources

PubMed2006

Methylprednisolone-induced toxic hepatitis.

OBJECTIVE: To report the third published case, as of April 8, 2006, of methylprednisolone-induced toxic hepatitis. CASE SUMMARY: A 47-year-old woman was admitted to our clinic with weakness, fatigue, pruritus, and scleral icterus that had developed 10 days prior to presentation. She had been taking topiramate for one year for treatment of chronic isolated central nervous system vasculitis. One week before her symptoms developed, she had completed a self-prescribed 7 day course of oral methylprednisolone for treatment of left arm weakness. She believed that methylprednisolone was appropriate since it had been used previously for acute episodes of vasculitis. Results of liver function tests performed on admission were alanine aminotransferase 2478 U/L, aspartate aminotransferase 1600 U/L, total bilirubin 10 mg/dL, direct bilirubin 8 mg/dL, alkaline phosphatase 138 U/L, and gamma-glutamyl transferase 242 U/L. Topiramate and methylprednisolone were the only drugs she had been taking before admission, and no other causes of liver dysfunction (eg, infection, ischemia, systemic disease) were identified. Topiramate was stopped, and enzyme levels decreased to normal values within 45 days without treatment. There had been no increase in enzyme levels during hospitalization upon the accidental use of topiramate. Based on the history and laboratory findings, the final diagnosis was mixed hepatocellular and cholestatic liver injury caused by methylprednisolone. DISCUSSION: Steroids have rarely been associated with hepatotoxicity; moreover, they are the treatment of choice for severe hepatitis. To date, only 2 cases of methylprednisolone-induced hepatotoxicity have previously been reported. Our case is similar to those with regard to mixed hepatocellular and cholestatic liver injury. Resolution of the hepatotoxicity occurred after discontinuation of the drug, with conservative treatment measures. An objective causality assessment based on the Naranjo scale suggests that hepatotoxicity was probably related to methylprednisolone. CONCLUSIONS: Although rare, hepatotoxicity related to methylprednisolone should be considered in patients who develop elevated enzyme levels while receiving this steroid.

Chemical and Drug Induced Liver Injury↗

PubMed2006

Therapeutic endoscopic retrograde cholangiopancreatography and related modalities have many roles in hepatobiliary hydatid disease.

The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistent fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.

Algorithms↗

PubMed2005

Ewing sarcoma in a geriatric patient.

Ewing Sarcoma has been the second most common primary osseous malignancy in childhood and adolescence. It has been described as a highly aggressive neoplasm. This is the oldest case report in the literature with Ewing Sarcoma.

Adolescent↗

PubMed2004

Coeliac crisis in adults: report of two cases.

Adult coeliac disease, in contrast to its childhood counterpart, almost always has an indolent course with a wider spectrum of clinical manifestations. Approximately half of the patients have no overt gastrointestinal symptoms and many are asymptomatic. A rare and life-threatening complication, affecting mainly children younger than 2 years of age, is the so-called coeliac crisis, a term that applies to profuse diarrhoea leading to dehydration, hypokalemia, and acidosis. We report here two cases of adult coeliac disease that presented as coeliac crisis. Coeliac disease should be a differential diagnosis in adult patients with severe acute diarrhoea and acidosis, although a rare presentation.

Acidosis↗

PubMed2004

Inflammatory myoglandular polyp: a rare cause of hematochezia.

Inflammatory myoglandular polyp is characterized by inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic change. The etiology is obscure. Mucous diarrhea, tenesmus, and hematochezia are main symptoms. We hereby report an 80-year-old man with diagnosis of inflammatory myoglandular polyp.

Aged↗

PubMed2003

Diagnostic and therapeutic ERCP in hepatic hydatid disease.

BACKGROUND: This retrospective study evaluated the use of diagnostic and therapeutic ERCP in pre- and postoperative patients with hepatic hydatid disease. METHODS: For 8 years, ERCP was performed in 39 patients with hepatic echinococcal disease. Indications in the preoperative group of patients (n = 19) included a cholestatic enzyme profile in all cases; jaundice or acute cholangitis also was present in, respectively, 14 and 7 cases. In the postoperative group (n = 20), indications for ERCP included persistent external biliary fistula after surgery in 10 patients, jaundice in 8, acute cholangitis in 7, and right upper quadrant pain in 2 patients. RESULTS: ERCP findings in the preoperative group included cystobiliary fistula (9 patients), external compression of the hepatic biliary system (5), hydatid vesicles and/or membranes within the biliary tract (3), intrahepatic duct stricture (1), and a normal cholangiogram (4). The most common ERCP finding in the postoperative group was external biliary fistula (10 patients); other findings consisted of hydatid cyst material within the bile duct (4), bile duct stenosis (2), cystobiliary fistula and hydatid cyst material in the bile duct (1), cystobiliary fistula (1), hydatid membranes in the gallbladder (1), extrinsic compression to bile ducts (1), and a normal cholangiogram (1). In the preoperative group, endoscopic sphincterotomy was performed in 11 patients, with balloon catheter extraction in 2; complete resolution of findings was achieved in 10 cases. In the postoperative group, sphincterotomy (with balloon or basket extraction as needed) was performed in 19 patients, stents were placed in 2 patients, 1 patient underwent balloon dilatation, and 1 had nasobiliary drainage; there was complete resolution of the findings in 14 of the 20 patients. CONCLUSIONS: ERCP and related therapeutic maneuvers are safe and valuable in the pre- and postoperative management of patients with hepatic hydatid disease.

Adult↗

PubMed2003

A rare entity in the rectum: malignant melanoma.

Malignant melanoma is a rare entity in the rectum. Long-term survival is rare, as most patients die of disseminated systemic disease regardless of treatment. For this reason, some authors do not consider extensive radical surgery as the treatment of choice. We describe here a case of this rare entity.

Digital Rectal Examination↗

PubMed2002

Absence of the common bile duct and junction of the cystic duct with the left hepatic duct in a patient with chronic portal vein thrombosis.

A50-year-old male patient was admitted to the hospital because of fatigue and a palpable abdominal mass. The diagnoses of chronic renal failure and portal vein thrombosis were established by specific investigations. Incidentally, junction of the cystic duct with the left hepatic duct and absence of the common bile duct were found during endoscopic retrograde cholangiopancreatography study. To the authors' knowledge, this is the first reported case of an absence of the common bile duct and junction of the cystic duct with the left hepatic duct in a patient with chronic portal vein thrombosis. Such lesions may cause unexpected complications during biliary surgery.

Chronic Disease↗

PubMed2002

Endoscopic therapy in the management of hepatobiliary hydatid disease.

Hydatid disease constitutes a serious public health problem throughout the world, especially in endemic areas, despite the use of various kinds of preventive measures. Currently, there are three treatment options for hepatic hydatid disease including surgery, PAIR (puncture, aspiration, injection, and re-aspiration), and chemotherapy with benzimidazole compounds. Each of these therapeutic modalities has limitations depending on the individual case. The authors review the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease (HHD) to clarify its place in the treatment algorithm among surgical, medical, and percutaneous measures. ERCP in the preoperative period: (1) defines the cystobiliary relationship to help in surgery planning, (2) permits evaluation for acute conditions like cholangitis and obstruction so that subsequent surgery can be performed on an elective basis, (3) may give permanent cure specifically in cases of frank intrabiliary rupture if evacuation of biliary tract and cystic cavity is manageable, and (4) when combined with preoperative endoscopic sphincterotomy may decrease the incidence of the development of postoperative external fistula. ERCP in the postoperative period: (1) can help to clarify the causes of ongoing or recurrent symptoms or laboratory abnormalities, (2) may help to resolve the obstruction or cholangitis due to residual material in biliary ducts, (3) may provide the chance to manage postoperative external biliary fistulae, and (4) may be a realistic solution for secondary biliary strictures. Considering the current literature and adding this experience, the authors propose a new treatment algorithm in HHD including medical, surgical, PAIR, and ERCP-related therapies. To illustrate the algorithm, a case is presented of a patient who had a persistent external biliary fistula in the postoperative period and was managed successfully by endoscopic approach.

Adult↗

PubMed2002

Interferon therapy for acute hepatitis C during pregnancy.

OBJECTIVE: Due to their antiproliferative activity, the probable effects of interferons on a fetus are a concern. We report on a pregnant patient who developed acute hepatitis C during pregnancy and was treated with a short course of interferon alfa therapy with a successful outcome. CASE SUMMARY: A 26-year-old woman was diagnosed with acute hepatitis C at the 16th week of pregnancy. She received a total dose of 72 million units of interferon alfa-2b during a 2 1/2 month period. Although the therapy was discontinued due to adverse effects, a complete biochemical and virologic response was obtained. Premature labor occurred and healthy, but growth-restricted, twin infants were born transvaginally. At 18 months of age, they had normal development, with a negative hepatitis C serology. DISCUSSION: The rate of transmission of hepatitis C virus from mother to infant is within the range of 1-5%. Although acute hepatitis C during pregnancy is a very rare occurrence, the mother is at a great risk for chronic infection. There is scarce literature about the probable effects of interferon use during pregnancy due to a lack of controlled studies in this special population. A total of 8 infants, including ours, exposed to interferon alfa and/or ribavirin during pregnancy showed no congenital anomalies or malformations. CONCLUSIONS: Patients with chronic hepatitis whose therapy can be delayed should not be treated with interferon due to a lack of controlled studies. However, women exposed to interferon inadvertently during pregnancy may be encouraged to continue pregnancy. In patients with acute hepatitis C during pregnancy, the use of interferon therapy should be considered with close monitoring.

Adult↗

PubMedDate not supplied

Evaluation of the Helicobacter pylori stool antigen test (HpSA) for the detection of Helicobacter pylori infection and comparison with other methods.

BACKGROUND/AIMS: Several invasive and non-invasive methods are available for the detection of H. pylori infection. The accuracy of anti-H. pylori antibodies in serum is low. There is a need for a quick, inexpensive and reliable non-invasive test to detect H. pylori. The aim of this study was to evaluate the enzyme immunoassay for the detection of H. pylori antigen in stool in the Turkish population and compare it to other methods. METHODOLOGY: 50 patients who were admitted to Hacettepe University Department of Internal Medicine, Division of Gastroenterology with the symptom of dyspepsia for whom the indication of upper gastrointestinal endoscopy was present were included in the study. With their permission stool samples were taken. The patients were evaluated with histology, culture, serology, rapid urease test and HpSA (Helicobacter pylori Stool Antigen test). Forty-one patients had gastritis and biopsies were taken from those. RESULTS: Excluding HpSA if three of the rest of four methods were positive, patients were accepted as H. pylori positive. Nineteen patients were positive for H. pylori, 22 were negative. HpSA was positive in 16 of 19. The sensitivity and specificity of the methods were as follows: histology 100% sensitive, and 86% specific, culture 63% and 100%, HpIgG 58% and 73%, rapid urease test 89% and 82%, respectively. The results were as 84% and 82% for HpSA. Comparing with the 'Gold Standard' histology using McNemar's test Kappa results were as 0.610, 0.181, 0.610, 0.708 for culture, HpIgG, Rapid Urease Test and HpSA, respectively. CONCLUSIONS: HpSA is a cheap, effective method for the diagnosis of H. pylori infection in the Turkish population.

Antigens, Bacterial↗