Background Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with symptoms of ileus and irreversible sclerosis of both visceral and parietal peritoneum. Peritoneal dialysis (PD) patients rarely develop EPS, a severe life-threatening condition of unknown pathogenesis. Angiotensin II is known to promote fibrosis and inflammation in various tissues. Renin–angiotensin system (RAS) blockade provides advantages in the course of diseases such as hypertension, chronic kidney disease, and proteinuria. We have also previously shown that RAS blockade has beneficial effects on hypertonic (3.86%) PD solution-induced peritoneal alterations. Because it shares the same characteristics as other fibrotic processes, peritoneal fibrosis can benefit from RAS blockade. Objective To determine the advantages of RAS blockade in regression of EPS. Methods We divided 56 nonuremic albino Wistar rats into 6 groups: control group ( n = 10), daily intraperitoneal (IP) injection of 2 mL isotonic saline for 3 weeks; CG group ( n = 10), daily IP injection of 2 mL/200 g chlorhexidine gluconate (CG) for 3 weeks; resting group ( n = 10), daily IP injection of CG (0 – 3 weeks) plus peritoneal rest (4 – 6 weeks). After 3 weeks of being injected with CG (0 – 3 weeks), a fourth group ( n = 9) was treated with 100 mg/L enalapril (ENA group); a fifth group ( n = 10) was treated with 80 mg/L valsartan (VAL group), and a sixth group ( n = 7) was treated with 100 mg/L enalapril + 80 mg/L valsartan (ENA+VAL group) in drinking water for an additional 3 weeks (4 – 6 weeks). At the end, a 1-hour peritoneal equilibration test was performed with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio of urea (D/P urea), dialysate WBC count, ultrafiltration volume (UF), and morphological changes of parietal peritoneum were examined. Results Exposure to CG for 3 weeks resulted in alterations in peritoneal transport (increased D/P urea, decreased UF volume; p < 0.05) and morphology (increased inflammation, neovascularization, fibrosis, and peritoneal thickness; p < 0.05). Peritoneal rest had some beneficial effect only on UF failure and dialysate cell count ( p < 0.05). However, RAS blockade was more effective than peritoneal rest with respect to UF volume, vascularity ( p < 0.05), and peritoneal thickness ( p > 0.05). Dual blockade of RAS had no additional beneficial effects. Conclusion We suggest that RAS blockade either with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may be a more effective option than resting in the management of EPS.

Long-term use of the peritoneum as a dialysis membrane results in progressive irreversible dysfunction, described as peritoneal fibrosis. Oxidative stress during peritoneal dialysis has been established in many studies. Generation of reactive oxygen species (ROS) by conventional peritoneal dialysis solutions, regardless of whether produced by high glucose, angiotensin II, or glucose degradation products may be responsible for progressive membrane dysfunction. The well-known antioxidant molecule N-acetylcysteine (NAC) is capable of direct scavenging of ROS. The aim of the present study was to investigate the effect of NAC therapy on both progression and regression of encapsulating peritoneal sclerosis (EPS). We divided 49 nonuremic Wistar albino rats into four groups: Control group—2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for a total of 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal resting (weeks 4 – 6); NAC-R group—CG (weeks 1 – 3), plus 2 g/L NAC (weeks 4 – 6). At the end of the experiment, all rats underwent a 1-hour peritoneal equilibration test with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio (D/P) urea, dialysate white blood cell count (per cubic milliliter), ultrafiltration (UF) volume, and morphology changes of parietal peritoneum were examined. The CG group progressed to encapsulating peritoneal sclerosis, characterized by loss of UF, increased peritoneal thickness, inflammation, and ultimately, development of fibrosis. Resting produced advantages only in dialysate cell count; with regard to vascularity and dialysate cell count, NAC was more effective than was peritoneal rest. Interestingly, we observed no beneficial effects of NAC on fibrosis. That finding may be a result of our experimental severe peritoneal injury model. However, decreased inflammation and vascularity with NAC therapy were promising results in regard to membrane protection.

Occult hepatitis B virus (HBV) infection is defined as the detection of HBV genome in the liver and/or serum in HBsAg(-) individuals. Most patients with occult HBV infection are asymptomatic and are usually diagnosed during screening. Occult HBV infection is clinically significant because it spreads through blood transfusion and organ transplantation and triggers the reactivation of HBV in immunosuppressive patients. In this paper, we present a 63-year-old patient with occult hepatitis B who was scheduled for chemotherapy due to Hodgkin's lymphoma, and developed hepatitis B reactivation after chemotherapy while being HBsAg(-) and anti-HBs(-) before chemotherapy.

Ge liş ta ri hi/Re cei ved: 09.06.2013 Ka bul ta ri hi/Ac cep ted: 13.07.2013 © Viral Hepatit Dergisi, Ga le nos Ya y› ne vi ta ra f›n dan ba s›l m›fl t›r. / Viral Hepatitis Journal, pub lis hed by Ga le nos Pub lis hing. ABS TRACT Objective: Hepatitis C virus (HCV) infects 1-5% of the world population, around 1% of our country. The risk of chronic infection after an acute episode of hepatitis C is near 80%. Generally its course is primarily insidious but eventually it can cause cirrhosis and hepatocellular cancer, because of that it can be a serious health problem. Standart therapy for patients chronically infected with HCV is combination pegylated interferon alpha plus ribavirin. In patients with HCV genotype 1 infection have shown that addition of protease inhibitors to the standard of care, markedly increased the rate of sustained virological response. We aimed to evaluation of chronic hepatitis C patients follow-up outcomes who admitted to our clinic. Materials and Methods: We enrolled the patients that who diagnosed (previously or new) with HCV, were registered, were initiated treatment (previously or new), were with adequate information in their files who admitted to Harran University Gastroenterology Clinic. We evaluated that clinical, laboratory, treatment, follow-up and prognostic features of the patients retrospectively. Results: The mean age of the patients was 54.6±11 years and 26 of 46 patients (56.5%) were female. The distribution of genotypes of the patients whose looked to genotypes were 85.2% genotype 1, 11.1% genotype 2 and 3.7% genotype 4. Seventeen (37%) of the patients had cirrhosis. Thirty-two (70%) of the patients received or are receiving pegylated interferon alpha/ribavirin treatment. There are 12 patients who taken complete therapy. Five (41.6%) of the patients have achieved sustained virological response, 5 (41.6%) of the patients were relapser and 2 (17%) of the patients were evaluated as breakthrough. Telaprevir, pegylated interferon, ribavirin triple treatment was initiated to 2 relapser and 1 patient of evaluated as breaktrough. Fourth week HCV-RNA were negative all of 3 patients who initiated triple therapy. Three (6.5%) of the patients were with HCC. Two (4%) of 46 patients died at follow-up. Conclusion: As a result, 80% genotype 1, 37% cirrhotic, sustained virological response rate 40% of the patients who we evaluated. Triple treatment was initiated to 3 patients and achieved rapid virological response. HCC was detected at 3 patients and 2 patients died. Chronic HCV is a mortal and morbid disease.

Bezoar, yabancı cisim veya gıdaların beslenme yolunda oluşturduğu kitlelerdir. Mide operasyonu geçirmiş olanlarda bezoar sıklığı artmaktadır. İnce barsakta bezoar az görülür ve nadiren ileusa neden olabilir. Bu yazıda, duodenuma yerleşmiş bezoarı olan, gastrik ameliyat geçirmiş, 55 yaşında kadın hasta sunulmuştur. Hastada bezoarın mideye alınmasını takiben ileus gelişmiş ve laparotomi yapılmıştır. Hasta ameliyattan bir hafta sonra şifa ile taburcu edilmiştir.