Kadir Bahar

Ankara University, Engüri, Ankara, Turkey

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Publications (39)102.58 Total impact

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    ABSTRACT: Background/aims: The aims of the present study were to review biliary complications following liver transplantation in a single-center experience, to identify the factors associated with biliary complications, and to evaluate the success of endoscopic and percutaneous treatment in such patients. Materials and methods: Between January 1994 and June 2010, a total of 176 patients with liver disease underwent liver transplantation; 119 recipients were included in this retrospective analysis. Median posttransplant follow-up period was 49 months. Results: Mean age was 43.0±12.7 years. Living donor liver transplantation (LDLT) and deceased-donor liver transplantation (DDLT) were performed in 71 and 48 patients, respectively. Duct-to-duct anastomosis and Roux-en-Y hepaticojejunostomy were performed in 68 and 51 patients, respectively. The overall incidence of posttransplant biliary complications was 36%; anastomotic biliary strictures were the most common biliary complications (42%), followed by biliary leakage (28%). On logistic regression analysis, duct-duct anastomosis was the only risk factor associated with the development of biliary complications (Odds ratio (OR), 3.346; p=0.005). Endoscopic and percutaneous treatment was successful in the majority of patients (81%), and the remaining 19% recipients underwent surgery for biliary repair. Endoscopic retrograde cholangiopancreatography (ERCP) guided drainage and balloon dilatation with stent placement were the most common treatment modalities. Conclusion: Biliary complications were most frequent after liver transplantation; biliary strictures were the most commonly seen. The use of duct-to-duct anastomosis for biliary reconstruction is a risk factor for the development of biliary complications. Endoscopic and percutaneous treatment was successful in the majority of these patients.
    Preview · Article · Apr 2014 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
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    ABSTRACT: Introduction/aim Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. Method The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. Results Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mm Hg): (24 vs 20, p = 0.033); median esophageal contraction amplitude (mm Hg): (71 vs 56, p = 0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p < 0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p = 0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p = 0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). Conclusion Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.
    Full-text · Article · Mar 2014 · European Journal of Internal Medicine
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    ABSTRACT: Purpose: To determine utility of proton density fat fraction (PDFF) measurements for quantifying the liver fat content in patients with nonalcoholic fatty liver disease (NAFLD), and compare these results with liver biopsy findings. Materials and methods: This retrospective study was approved by the institutional review board with waivers of informed consent. Between June 2010 and April 2011, 86 patients received a diagnosis of NAFLD. Ten patients did not accept liver biopsy and six patients had contraindications for magnetic resonance (MR) imaging. Seventy patients were included in this study. Seventy patients with NAFLD (40 men, 30 women; mean age, 44.7 years; range, 16-69 years) underwent T1-independent volumetric multiecho gradient-echo imaging with T2* correction and spectral fat modeling. Median time interval between MR imaging and liver biopsy was 14.5 days (range, 0-259 days). MR examinations were performed with a 1.5-T MR imaging system. Complex-based PDFF measurements were performed by placing regions of interest in Couinaud system segments V-VI and all liver segments from I to VIII. All liver biopsy specimens were retrieved from archives and evaluated by one pathologist for hepatic steatosis according to criteria from a previous study. Pearson correlation coefficient, receiver operating characteristics, and linear regression analyses were used for statistical analyses. Results: Mean PDFF calculated with MR imaging was 18.1% ± 9.5 (standard deviation). Close correlation for quantification of hepatic steatosis was observed between PDFF and liver biopsy (r = 0.82). PDFF was effective in discriminating moderate or severe hepatic steatosis from mild or no hepatic steatosis, with area under the curve of 0.95. The correlation between biopsy and PDFF-determined steatosis was less pronounced when fibrosis was present (r = 0.60) than when fibrosis was absent (r = 0.86; P = .02). Conclusion: PDFF measurement by MR imaging provided a noninvasive, accurate estimation of the presence and grading of hepatic steatosis in patients with NAFLD. Hepatic fibrosis reduced the correlation between biopsy results and PDFF.
    Full-text · Article · Feb 2013 · Radiology
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    ABSTRACT: PURPOSE The aims of the present study were to determine the efficiency of proton density fat fraction (PDFF) calculation in assessing the presence of and in quantifying the liver fat content in individuals with nonalcoholic fatty liver disease (NAFLD), as compared to liver biopsy. METHOD AND MATERIALS A total of 70 NAFLD patients underwent T1-independent volumetric multi-echo gradient-echo imaging with T2* correction and spectral fat modeling. Complex type PDFF calculation was performed in all liver segments. MRI examinations were performed on a 1.5T MRI system. All liver biopsy specimens were retrieved from the archives and evaluated by one pathologist. RESULTS The median interval between the liver biopsy and PDFF calculation was 14.5 days. The mean PDFF calculated with MRI was 18.1%±9.5. A close correlation was observed between PDFF calculation and liver biopsy in terms of the quantification of hepatic steatosis (rs=0.809, p<0.001). This correlation was present in the different percentages of hepatic steatosis. PDFF well discriminated moderate/severe hepatic steatosis from none/mild hepatic steatosis with AUC of 0.95, p<0.001. No significant difference in terms of the estimated fat fraction between different liver segments was observed. With linear regression analysis, the presence of hepatic fibrosis was determined to influence inversely on the estimation of hepatic fat content with PDFF (p<0.001). CONCLUSION PDFF calculation by MRI provides a non-invasive, accurate estimate of the presence and grading of hepatic steatosis in the whole liver. Hepatic fibrosis interferes with the estimation of hepatic steatosis using this imaging. CLINICAL RELEVANCE/APPLICATION Proton density fat fraction provides a non-invasive, accurate estimate of the presence and grading of hepatic steatosis in the whole liver.
    No preview · Conference Paper · Nov 2012
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    ABSTRACT: Familial Mediterranean fever is an autosomal recessive disease characterized by recurrent fever and peritoneal and pleural inflammation. It is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. A small amount of peritoneal fluid collection can be observed during peritoneal attacks in patients with Familial Mediterranean fever, but chronic ascites has been described rarely in these patients. A 42-year-old female patient was admitted to our clinic in June 2010 with fever, severe abdominal pain and abdominal distention that had continued for one month. There was no family history of periodic fevers or abdominal pain. We could not find any cause for ascites, including tuberculosis. A diagnosis of Familial Mediterranean fever was suspected based on the clinical findings and her family history. She was screened for mutations causing Familial Mediterranean fever, and when found to be homozygous for M694V, treatment with colchicine was initiated. After treatment, the amount of ascites decreased, and relief of symptoms was confirmed during a follow-up. In conclusion, because Familial Mediterranean fever is common in our country, it should be considered in the differential diagnosis of patients with ascites of unknown etiology in populations where hereditary inflammatory disease is endemic.
    No preview · Article · Jun 2012 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
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    ABSTRACT: The aims of this study were to assess hepatitis B surface antigen (HBsAg) seroconversion and to determine its impact on the natural course of the disease in patients with HBeAg-negative chronic hepatitis B (CHB) during lamivudine (LMV) treatment. A total of 183 consecutive patients with HBeAg-negative CHB who were treated with LMV were included in the study. Data were retrospectively collected from outpatient visit charts. The primary endpoint was HBsAg seroconversion to anti-HBs. The secondary endpoint was to determine the development of cirrhosis. Loss of HBsAg was confirmed in 10 patients and seroconversion to anti-HBs in nine patients during LMV treatment or after its discontinuation. HBsAg seroconversion was achieved on-treatment in four patients after a median treatment duration of 30 months and off-treatment in the remaining five patients in a median 61 months after LMV discontinuation. The cumulative probability of HBsAg seroconversion increased from 0.6% at 1 year and 1.9% at 5 years to 21.5% at 10 years of LMV during and after LMV treatment. HBsAg clearance was preceded by undetectable serum hepatitis B virus (HBV) DNA. The majority of the patients responding to treatment had undetectable HBV DNA levels at 24 weeks of treatment. The cumulative probability of LMV resistance increased from 2.2% at 1 year to 37.3% at 5 years. No baseline parameter predicting either HBsAg seroconversion or the emergence of LMV resistance was identified. None of the patients with HBsAg seroconversion experienced virological breakthrough or disease progression during the follow-up period. These results indicate that HBsAg seroclearance can occur in patients with HBeAg-negative CHB under LMV therapy and predicts better clinical outcome.
    No preview · Article · Mar 2012 · Journal of Viral Hepatitis
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    ABSTRACT: Excessive release of gastrin leads to hypertrophy and hyperplasia of enterochromaffin-like cells (ECL) and prolonged stimulation of these cells causes functional impairment. The purpose of this study was to investigate the effect of Helicobacter pylori (H. pylori) infection and long-term proton pump inhibitors (PPI) use on ECL cells. Fifteen patients who underwent endoscopy because of dyspeptic symptoms were enrolled in the present study. Biopsies were taken from corpus and antrum and existence of H. pylori was investigated with culture, cytology and CLOtest. The patients were divided into 3 groups. Group-A: H. pylori-negative, never treated previously with PPI; Group-B: H. pylori-positive, never treated previously with PPI; and group-C: H. pylori-negative and continuously treated with PPI for more than 6 months before the subject recruitment period. The features of ECL cell in oxyntic glands were examined with electron microscopy on biopsy specimens. ECL cells were completely normal in Group A. In group B, moderate hyperplasia and vacuolization was seen in ECL cells. In group C, ECL cell hyperplasia was observed and vacuoles with greater amounts of granules in enlarged vesicles were found more intensely in cytoplasm. The use of PPI for a long period of time and presence of H. pylori infection are risk factors for ECL hyperplasia.
    Full-text · Article · Feb 2012 · Annals of Gastroenterology
  • Bektas M · Korkut E · Ramazan I · Keskin O · Üstün Y · Gupta V · Bahar K

    No preview · Article · Feb 2011
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    ABSTRACT: The success of Helicobacter pylori eradication using triple eradication therapy declines over time. In this prospective study, we have compared a group of naive H. pylori-positive patients receiving sequential therapy with our previously published naive H. pylori-positive control group who received ranitidine bismuth citrate-clarithromycin-amoxicillin eradication treatment. Moreover, the eradication success of these two treatment protocols was compared with that of recent standard triple eradication treatment results for the naive patients in our country and western communities. We performed invasive tests for H. pylori in naive patients who underwent gastroduodenoscopy in the Endoscopy Unit, Ankara University, Faculty of Medicine, and patients who were diagnosed as H. pylori-positive by these tests were rechecked by the same invasive tests one month after the completion of eradication treatment. The group receiving sequential therapy was given pantoprazole + amoxicillin during the first seven days and pantoprazole + metronidazole + tetracycline during the second seven days. These patients were compared with the H. pylori-positive naive control group patients, who were given ranitidine bismuth citrate + clarithromycin + amoxicillin. The patients in whom eradication was achieved in the 4th week with sequential therapy were reevaluated one year later regarding the success of eradication with the H. pylori stool antigen test. The average age of the 108 patients who received the sequential therapy was 45.2±12.5 years. The average age of the 75 patients who received ranitidine bismuth citrate treatment was 41.2±12.6 years. Six (5%) patients in the consecutive treatment group developed deterioration in taste in the mouth and 10 (9%) developed diarrhea. However, no side effects severe enough to require discontinuation of the treatments were observed in either treatment group. The results of the invasive tests were evaluated by the end of the first month, and revealed an eradication rate of 88% in the sequential treatment group versus 95% in the ranitidine bismuth citrate treatment group. Sixty-eight of 94 patients in whom eradication was achieved by sequential therapy were reevaluated with H. pylori stool antigen test in one year, and eradication was found to persist in 52 (77%) of these 68 patients. High rates of eradication were achieved in both groups in the 4th week evaluation. It was observed at the follow-up performed one year later that the eradication achieved with sequential therapy persisted in 77% of the patients treated.
    Preview · Article · Sep 2010 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
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    ABSTRACT: The aim of this cohort study was to determine the characteristics and clinical outcome of 170 patients with drug-induced liver injury (DILI) in a single center. Between January 2001 and June 2007, a total of 170 individuals who were diagnosed with DILI were retrospectively analyzed. The median follow-up period was 110.0 days. During the study period, a total of 5471 new patients were assessed for liver test abnormalities. Of those, 170 patients (3.1%) fulfilled the criteria of DILI. A total of 83 different drugs were considered to be related to the hepatotoxicity; a single drug was suspected in 57.6% of individuals. The median interval between the suspicious drug intake and DILI recognition was 15.0 days. Hepatocellular pattern was observed in 50.0% of patients with a mean alanine aminotransferase level of 952.2+/-907.0 U/L. The main causative group of drugs was antibiotics. Sixty-two patients required hospitalization; acute liver failure developed in 14 (8.2%), chronicity was observed in 19 (11.2%), and 7 died (4.1%). Overall, complete recovery occurred in 82% of patients. The presence of jaundice on admission and shorter interval period between drug intake and DILI recognition were identified as risk factors for the development of acute liver failure. DILI is an important cause of liver test abnormalities in outpatient clinics, and antibiotics represent the most common drug group. Overall, complete recovery after the withdrawal of the suspicious drug occurred in the majority of patients, but DILI may progress to acute liver failure, chronicity, and death.
    Full-text · Article · Jul 2010 · Journal of clinical gastroenterology
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    ABSTRACT: Oral sodium phosphate is an agent used commonly in our country for cleaning the intestines before colonoscopy. Our aim was to compare the safety, tolerability and efficiency of oral sodium phosphate solution used in colonoscopy preparation in patients over 70 years of age. This study was carried out in Ankara University School of Medicine Cebeci Hospital Endoscopy Center between August 2008 and March 2009. The extent of colon cleanliness was scored in the colonoscopy procedure. The data from the two groups were compared. In our study, 55 patients were divided into two groups according to their age, as over 70 years (n: 25) and under 70 years (n: 30). The average age of the group under 70 years was 49.4±9.8 and of the group over 70 years was 71.4±1.2 (p=0.04). Among the patients included in this study, 59.1% were female (n: 28) and 50.9% were male (n: 27). In the over 70 years group, the intestinal cleanliness was poor-fair in 2 patients, acceptable in 7 patients and excellent in 16 patients. In the below 70 years group, the intestinal cleanliness was poor in 2 patients, acceptable in 9 patients, good in 13 patients, and excellent in 6 patients. In the statistical evaluation, it was determined that there was no statistical difference between the over- and below 70 years of age groups regarding good-excellent intestinal cleanliness and poor-medium intestinal cleanliness (p=0.109). There was no statistical difference between the groups with regard to the adverse effects. The sodium, potassium and creatinine levels were assessed on the procedure day in 5 patients with clinical side effects (abdominal pain, nausea, vomiting, dizziness, hypotension) in the elderly group. No electrolyte imbalance or renal function impairment was observed in these patients. In the group of patients over 70 years old, a special patient group without comorbid diseases, oral sodium phosphate solution used for colon preparation was effective and well-tolerated with a low adverse effect rate. In spite of this safe profile, since serum creatinine levels and electrolyte imbalance were assessed in only a limited number of patients, the relationship reported in the literature between oral sodium phosphate and electrolyte imbalance and renal function impairment should be kept in mind.
    No preview · Article · Jun 2010 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
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    ABSTRACT: Obstructive jaundice is an unusual manifestation of non-Hodgkin lymphomas in children. Although surgical drainage is one of the initial treatment choices in some cases, usually lymphomatous masses rapidly response to chemotherapy and jaundice decreases due to regression of the mass, without any surgical procedure. The authors report the case of a 16-year-old girl who presented with biliary obstruction due to a neoplasm involving the duodenum. Histological examination of the specimen, which was taken from the mass by endoscopic biopsy, revealed Burkitt lymphoma infiltrating the duodenum. Chemotherapy including cyclophosphamide was started immediately. In a few days, jaundice decreased rapidly by the shrinkage of the mass. Neither surgery nor percutaneous drainage were needed. In conclusion, biliary tract obstruction due to non-Hodgkin lymphoma can be effectively treated with chemotherapy alone without any surgical procedure.
    No preview · Article · Jan 2006 · Pediatric Hematology and Oncology
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    ABSTRACT: Thrombophilic gene mutations have been reported to be associated with the formation of portal vein thrombosis (PVT). This study aimed to investigate the role of thrombophilic gene mutations in cirrhotic patients with PVT. A total of 74 cirrhotic patients (17 with PVT, 57 without PVT), and 19 non-cirrhotic patients with PVT and 80 healthy controls were included. Factor V Leiden G1691A, prothrombin G20210A and methylenetetrahydrofolate reductase C677T mutations were analysed by restriction fragment length polymorphism. Aetiologies and Child-Pugh distribution of cirrhotic patients with and without PVT were similar. Five of 17 (29%) of cirrhotic patients with PVT but only two of 57 (3.5%) of cirrhotics without PVT, five of 80 (6%) of controls and none of the 19 non-cirrhotic patients with PVT had factor V Leiden G1691A mutation (P<0.05). Prothrombin G20210A mutation was found in five (29%) cirrhotic patients with PVT while only two (3.5%) cirrhotic patients without PVT, one (5%) non-cirrhotic patient with PVT and two (2.5%) controls had this mutation (P<0.05). The frequency of the homozygote methylenetetrahydrofolate reductase 677C-T mutation was similar in all four groups. Inherited thrombophilic gene mutations appear to increase the risk of PVT formation in cirrhotic patients but not in patients without liver disease in a cohort of Turkish patients.
    No preview · Article · Mar 2005 · European Journal of Gastroenterology & Hepatology

  • No preview · Article · Aug 2004 · Journal of Gastroenterology and Hepatology
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    ABSTRACT: To evaluate the importance of fine needle aspiration cytology (FNAC) in the diagnosis of hepatocellular carcinoma (HCC). We analyzed 17 cytologic and 5 architectural features in a series of 320 FNACs from HCC and compared them with 73 FNACs from benign lesions and with 705 FNACs from metastatic carcinomas. One thousand ninety-eight patients who were diagnosed by liver FNAC between December 1988 and July 1998 and had adequate follow-up were included in the study. The specimens were evaluated according to the presence or absence of the cytologic features and cellular arrangement. A stepwise logistic regression analysis was performed on the data to determine the variables predictive of HCC. Multinucleated tumor giant cells, cytoplasmic hyaline and central sinusoidal pattern were selected as the 3 most predictive parameters for differentiated reactive hepatocytes from HCC (P < .0001), while bile, centrally located nucleus in an atypical cell and intranuclear inclusion were selected as the 3 most predictive parameters for differentiated metastatic carcinoma from HCC (P < .0001-< .001) by stepwise logistic regression analysis. In the 1,098 patients suspected of having hepatic malignancy, a correct diagnosis was made by a combination of the above features. The sensitivity of this procedure for hepatic malignancy was 99.5%, and the specificity was 100%.
    No preview · Article · Jul 2003 · Acta cytologica
  • S Karayalcin · K Bahar · S Bilgic · A Erden

    No preview · Conference Paper · Apr 2003
  • I. Soyuer · C. Ekinci · M. Kaya · Y. Genç · K. Bahar
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    ABSTRACT: One hundred liver fine-needle aspiration cytology (FNAC) specimens obtained from 42 patients with hepatocellular carcinomas (HCC), 38 patients with metastatic adenocarcinomas (MAC) and 20 patients with non-malignant liver disease (control group) were studied. Liver specimens were stained with an immunoperoxidase method using a monoclonal antibody to Ki-67 (MIB1). Ki-67 antigen was visualised in cold acetone, and a fresh liver needle aspiration cytology specimen using antibodies was used to identify proliferating hepatocytes. In this study it was examined that; if there is a difference between the groups in terms of Ki-67 positivity and degree of differentiation of tumor and the relationship there in. The Ki-67 labeling index (LI) of HCC cases was significantly different from the other two groups (p < 0.01). In additions, the numbers of hepatocytes positive for Ki-67 has a good correlation with the degree of differentiation of HCC (t = 2.96, p < 0.01).
    No preview · Article · Jan 2003 · Turkish Journal of Medical Sciences
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    S Cesur · K Bahar · S Erekul
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    ABSTRACT: Death from cumulative sodium stibogluconate toxicity on Kala-Azar Pentavalent antimonial compounds are the most widely used drugs for the treatment of leishmaniasis, but side-effects are frequent [1]. We report the case of a 4-year-old-male who was diagnosed with visceral leishmaniasis after examination of a bone marrow biopsy. The patient was started on 20 mg/kg intravenous sodium stibogluconate daily (1200 mg/day) and 16 mg/kg oral allopurinol daily (100mg three times daily). This regimen was supplemented with albumin and blood. On day 3, he reported chest pain and persistent cough, and the drugs were withdrawn. Electrocardiography (ECG) was unremarkable at that time. Three days after the treatment had been discontinued, petechial rashes were seen on the lower extremities. Sepsis and other causes of petechial rash were ruled out. Three days after treatment was discontinued, the patient was found dead in bed. ECG showed ventricular fibrillation. Sodium stibogluconate with a valency of 5þ and meglumine antimonate are used in the treatment of leishmaniasis [1]. Stibogluconate sodium (Pentostam) is the term used in English-speaking countries, including the USA. Sodium stibogluconate solution contains about 10% pentavalent antimony (100 mg/mL) [1]. Side-effects include abdominal pain, vomiting, nausea, fatigue, headache, increase of liver enzymes, nephrotoxicity, arthralgia, fever, rash, cough, pneumonia, pancytopenia and reversible peripheral neuropathy. Recent studies suggest that elevations of amylase and lipase are common, and that a subset of patients suffer clinically significant pancreatitis. Nonetheless, these side-effects rarely lead to discontinuation of the drug [2–4]. Dose-related changes in ECG can also be seen. Nevertheless, serious side-effects, such as atrial and ventricular arrhythmia, atrial fibrillation, ventricular tachycardia, ventricular fibrillation, and torsade de pointes, are rare. Torsade de pointes induced by pentavalent antimony, followed by sudden death, has been observed [3–5]. Arrhythmias and sudden death have been reported with doses greater than 20mg/kg body weight/day [1]. Administration of the drug at normal doses rarely results in the death of patients. It should be kept in mindthat pentavalent antimony is contraindicated in patients with myocarditis, hepatitis and pancreatitis [6,7]. Even the normal dose of sodium stibogluconate can lead to both cardiotoxicity and hematotoxicity, because of its cumulative effects. These side-effects may occur even after the drug is withdrawn, as in our case. We therefore suggest that patients with leishmaniasis who are being treated with antimony compounds be observed cautiously for signs of cardiologic and hematologic changes. S. Cesur�, K. Bahar and S. Erekul Ankara U¨ niversitesi Ty´p Faku¨ ltesi Y ´ nfeksiyon Hastaly´klary´ve Kinik Bakteriyoloji, Anabilim Daly´ Sy´hhiye, 06100 Sy´hhiye-Ankara, Turkey �Tel: þ90 312 3103333 E-mail:scesur89@yahoo.com REFERENCES 1. Pearson DR, Sousa De Queiroz A. Leishmania species: visceral (Kala-azar), cutaneous, mucosal leishmaniasis. In: Mandell G, Bennett EJ, Dolin R, eds. Principles and practice of infectious diseases, 4th edn. New York: Churchill Livingstone, 1995. 2428–2442. 2. Hepburn NC, Tidman MJ, Hunter JA. Aminosidine versus sodium stibogluconate for the treatment of American cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 1994; 88: 700–3. 3. Thakur CP, Sinha GP, Pandey AK et al. Do the diminishing efficacy and increasing toxicity of sodium stibogluconate in the treatment of visceral leishmaniasis in Bihar, India, justify its continued use as a first drug? An observational study of 80 cases. Ann Trop Med Parasitol 1998; 92: 561–9. 4. Ortega-Carnicer J, Alcazar R, De la Torre M et al. Pentavalent antimonial-induced torsade de pointes. J Electrocardiol 1997; 30: 143–5. 5. Berman JD. Human leishmaniasis: clinical, diagnostic and chemotherapeutic development in the last 10 years. Clin Infect Dis 1997; 24: 684–703. 6. Donovan KL, White AD, Cooke DA et al. Pancreatitis and palindromic arthropathy with effusions associated with sodium stibogluconate treatment in renal transplant recipient. J Infect 1990; 21: 107–10. 7. Halim MA, Alfurayh O, Kalin ME et al. Successful treatment of visceral leishmaniasis with allopurinol plus ketoconazole in renal transplant recipient after the occurrence of pancreatitis due to
    Full-text · Article · Oct 2002 · Clinical Microbiology and Infection
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    ABSTRACT: In patients with Budd-Chiari syndrome due to short segment hepatic vein stenosis where percutaenous transluminal venoplasty is not successful, percutaneous transhepatic balloon venoplasty may be a valid treatment option. The aim of this prospective study was to evaluate the effects of this procedure for the treatment of patients with Budd-Chiari syndrome, in whom transluminal cannulation was unsuccessful. Ten patients with short segment occlusion of the hepatic veins were treated by percutaneous transhepatic balloon venoplasty between January 1997 and January 2000. The median follow-up period of these patients was 20 months (2-33 months). The procedure was unsuccessful in two patients. Eight patients (five men, three women) with a median age of 28 (range, 15-61) years were treated by percutaneous transhepatic balloon venoplasty and in seven of them, clinical symptoms including abdominal distension and ascites, resolved completely. Long term anticoagulation therapy was not given to the patients. One patient with advanced stage liver disease died of variceal bleeding two months after the procedure. During follow-up, symptomatic reocclusion requiring dilatation occurred in three patients. Percutaneous transhepatic balloon venoplasty is an alternative treatment option for selected patients with Budd-Chiari syndrome when transluminal cannulation of the hepatic veins is not possible. Long term anticoagulation therapy seems to be necessary in these patients.
    Preview · Article · Jul 2002 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
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    Işin Soyuer · Cemil Ekinci · Muhsin Kaya · Kadir Bahar
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    ABSTRACT: Fine needle aspiration biopsy is a useful tool in the diagnosis of primary malignancies and metastatic lesions of the liver. The aim of this study was to determine the types and features of tumors diagnosed by this method and the difficulties in differential diagnosis. Fine needle aspiration biopsy smears from 704 patients with metastatic liver lesions were reviewed. Among the metastastatic carcinomas in which their primary origin was identified, pulmonary carcinomas were the largest group. While colon adenocarcinoma was most prevalent (21.65%) where the primary origin of metastatic tumors was identified, followed by breast carcinoma (20.10%) and gastric adenocarcinoma (19.59%). The cases which cannot be differentiated from hepatocellular carcinoma in cytologic examination are invasive ductal carcinoma, renal cell carcinoma and squamous cell carcinoma. Pulmonary and colon carcinomas are the common metastatic tumors of the liver.
    Full-text · Article · Jul 2002 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology