Chylous ascites is the accumulation of lipid-rich lymph in the peritoneal cavity. The usual cause in adults is lymphatic obstruction or leakage caused by malignancy. Non-malignant causes include postoperative trauma, cirrhosis, tuberculosis, pancreatitis and filariasis. A variety of treatment options have been proposed for the management of chylous ascites; however, their effectiveness in idiopathic or primary form is unknown. Here we report a case of chylous acid rapidly resolved with the treatment of fasting, total parenteral nutrition and somatostatin analogue.

Experience with endoscopic retrograde cholangiopancreatography in the pediatric population is limited. The aim of this study was to evaluate the outcomes of ERCP in the pediatric population performed by adult gastroenterologists with standard duodenoscopes. This study is a structured retrospective review of endoscopic reports, computerized and paper medical records, and radiographic images of patients under the age of 18 who underwent ERCP for any indication at a tertiary referral centre. Data regarding demographic characteristics and medical history of patients, indications, technical success rate, final clinical diagnosis, and complications were analyzed. Forty-eight children with a mean age of 13 years (range 2–17) underwent a total of 65 ERCPs. The indications of ERCP were as follows; suspected choledocholithiasis (55 %), post-liver transplantation anastomotic biliary strictures (21 %), post-surgical bile duct injury (10 %), choledochal cyst (2 %), recurrent or chronic pancreatitis (10 %), and trauma (2 %). The cannulation success rate in the overall procedure was 93.8 %. Therapeutic interventions were performed in 70.7 % of patients. Post ERCP pancreatitis was the most common complication occurring in 9.2 % of patients, and no procedure related mortality occurred. When performed by well-trained adult gastroenterologists, the use of endoscopic retrograde cholangiopancreatography with standard duodenoscopes is safe in pediatric population.

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized with symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. There has been a dramatic increase in the diagnosis of this disease in recent years. The primary objective of this study was to determine the frequency of EoE in adult patients who were evaluated by gastroenterologists in our clinic with esophageal symptoms. Between November 2010 and May 2011, 311 adult patients who were evaluated in our clinic with esophageal symptoms were enrolled prospectively. All patients underwent endoscopy and had biopsies taken. Gastroesophageal reflux disease was excluded by either proton pump inhibitory treatment or 24-hour ambulatory pH monitorization. The diagnosis was confirmed by one independent pathologist. Frequency of EoE in patients with esophageal symptoms was 2.6% (n = 8; four men and four women). Mean age at diagnosis was 40.2 ± 8 years. Heartburn was the predominant symptom in patients (75% of the patients), and 87.5% (n = 7) of patients had more than one symptom at diagnosis. Nearly 38% of the patients (n = 3) had a history of allergic disease. Endoscopic findings were as follows: transient/fixed esophageal rings (25%), white exudates (25%), and normal appearance (50%). Median number of circulating eosinophils was 208 (93-659)/mm(3) . Median number of intraepithelial eosinophils in proximal-middle 1/3 part and distal 1/3 part of esophagus were 0 (0-50)/hpf and 37 (16-50)/hpf, respectively. In conclusion, EoE is not rare in Turkey, and it should be considered in the differential diagnosis of patients with esophageal symptoms.

Objectives:To observe the effects of both propofol/alfentanil and propofol/ketamine on sedation during upper gastrointestinal system endoscopy in morbidly obese patients (UGSEMOP).Methods:In a prospective, double-blinded, randomized clinical study, 52 patients scheduled for UGSEMOP were assigned to either group A (n=26; 10 µg/kg intravenous [IV] alfentanil) or group K (n=26; 0.5 mg/kg IV ketamine). Each patient was administered 0.7 mg/kg propofol for induction. If it was needed, the patients were administered an additional dose of IV propofol. This study was performed in Sehitkamil State Hospital, Gaziantep, Turkey, between January 2014-2015. Total propofol consumption, time to achieve Modified Aldrete Scores (MAS) of 5 and 10 following the procedure, physician and patient satisfaction scores, and instances of side effects, such as bradycardia and hypotension were recorded.Results:Time to onset of sedation and duration of sedation were both significantly shorter in group A. Patients in group A also required less time to achieve an MAS of 5. Total propofol consumption was significantly lower in group A.Conclusion:Both propofol/alfentanil and propofol/ketamine combinations provided appropriate hypnosis and analgesia during UGSEMOP. However, propofol consumption was significantly higher using the propofol/ketamine combination.

Background/Aims:The efficacy of immune response against hepatitis C virus (HCV) is determined by human leukocyte antigen (HLA) molecules of the host which present HCV antigens to CD4 + and CD8 + T lymphocytes. In this study, we aimed to investigate the possible relationship between the frequencies of certain HLA class I–II alleles and the natural history of HCV in patients with end-stage renal disease (ESRD).Settings and Design:This is a retrospective cohort study conducted in a university hospital.Patients and Methods:The present study comprised 189 ESRD patients (candidates for renal transplantation) who had positive anti-HCV antibody test. The results concerning HCV and HLA status were gathered from patients’ files. The viral persistence was compared between the groups that were determined by HLA sub-typing.Statistical Analysis:Statistical evaluation was performed using Mann–Whitney U-test, Chi-square test, and Fisher's exact test. Level of error was set at 0.05 for all statistical evaluations, and P values < 0.05 were considered statistically significant.Results:We found possible association between the course of HCV infection and specific HLA alleles. HLA class I Cw*6 and HLA class II DRB*10 alleles were observed more frequently in the viral clearance group (P < 0.05). The HLA class I B*38 allele group was more prone to develop chronic hepatitis C (P < 0.01).Conclusions:These findings suggest that HLA class I Cw*6 and HLA class II DRB*10 alleles may be associated with immunological elimination of HCV in Turkish patients on hemodialysis. HLA sub-typing could help predict the prognosis of HCV infection.