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Autoimmune hepatitis and long-term disease course in children in Turkey, a single-center experience
(Lippincott Williams & Wilkins, 2016) Karakoyun, Miray; Ecevit, Cigdem O.; Kilicoglu, Erhan; Aydogdu, Sema; Yagci, Rasit V.; Ozgenc, Funda
Introduction The aim of this study is to determine clinic and laboratory features, treatment protocols, treatment responses, and long term follow-up of children with autoimmune hepatitis (AIH) in a region of Turkey followed at Ege University. Materials and methods The records of 47 children with AIH between 1998 and 2012 were retrospectively analyzed for clinical profiles, treatment response, relapse rate, and long-term side effects. Results The median age of the children was 10 +/- 4.1 years (55.3% females). A total of 29 patients presented with chronic hepatitis (61.7%). According to the autoantibody profiles, 40 (85.1%) and seven (14.9%) cases were classified as type 1 and type 2, respectively. Presentation with acute hepatitis and chronic hepatitis was significantly higher in type 1 disease. Laboratory findings at presentation was found similar among races as well as AIH types (P>0.05). The prednisolone was used for remission induction in 37 patients; 86.4% (n: 32) achieved a complete response, 2.7% (n: 1) achieved a partial response, and four patients (10.8%) showed no response. Maintenance was attained by low-dose steroid plus thiopurine and relapse in steroid responders (n: 32) was 9.4% (n: 3) at 8, 12, and 48 months. A total of 36% (n: 24) had neither acute nor chronic treatment side effects. Bone marrow suppression was observed in five patients and hyperglycemia was observed in one patient (10.6 and 2.1%), respectively. Conclusion AIH type 1 prevails in children in a region of Turkey during the second decade of life. Low-dose corticosteroids combined with azathioprine are found. Eur J Gastroenterol Hepatol 28:927-930 Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
C-reactive protein in children with active ulcerative colitis
(Mosby-Elsevier, 2012) Ozgenc, Funda; Ecevit, Cigdem Omur; Yagci, Rasit Vural
Compound Heterozygote of a Novel Missense Mutation (p. K402T) and a Double Missense Mutation (p.[G71R;Y486D]) in Type II Crigler-Najjar Syndrome
(Lippincott Williams & Wilkins, 2011) Maruo, Yoshihiro; Ozgenc, Funda; Mimura, Yu; Ota, Yoriko; Matsui, Katsuyuki; Takahashi, Hiroko; Mori, Asami; Taga, Takashi; Takano, Tomoyuki; Sato, Hiroshi; Takeuchi, Yoshihiro
Determination of intracellular Th1/Th2 type cytokines in lymphocytes of chronic hepatitis B patients treated with interferon-alpha
(Turkish Soc Gastroenterology, 2010) Atan, Ozlem; Aksu, Guzide; Ozgenc, Funda; Akman, Sezin A.; Karaca, Neslihan Edeer; Sertoz, Ruchan; Yagci, Rasit Vural; Kutukculer, Necil
Background/aims: Host-related immune factors in childhood chronic hepatitis B and change in the initial profile with interferon (IFN)-alpha treatment need to be clarified. Methods: Sixteen patients were included in the study, and 10 million units of IFN-alpha treatment 3 times per week for 6 months was initiated. Pre- and post-treatment percentages of interleukin (IL)-2 and IFN-gamma in CD4+ T cells were assessed to determine intracellular T helper cell 1 (Thl) type cytokine expression. Similarly, percentages of intracellular IL-2 and IFN-gamma were detected to verify cytotoxic T cell 1 (Tc1) type cytokine expression in CD8+ T cells. Percentages of Th2 and Tc2 type cytokine expression (IL-4 and IL-13) were determined in CD4+ and CD8+ T cells, respectively. Resuts: Six (50%) of these were evaluated as having no response and the other half with partial complete response. All patients had higher percentages of Th2 cells with respect to healthy controls pre-treatment. Tc percentages, both Tc1 and Tc2, were significantly different between these groups, being higher in the patient group. When values of the nonresponder group were compared with healthy controls, IL-4 expression was higher and the percentages of Th1 type cells were significantly low. IL-13 expression in Th2 and Tc2 cells decreased after 6 months of treatment in the unresponsive group. The decrease we observed in Th1 percentages with treatment, in the responsive group, may be due to Thl deposition shifting from the periphery to liver tissue, as reported before. Intracellular cytokine profiles of treatment responders and normal controls were not different. Results: This is the first study in children comparing baseline and post-treatment intracellular cytokine profiles with values in healthy controls.
Early and Late Factors Impacting Patient and Graft Outcome in Pediatric Liver Transplantation: Summary of an ESPGHAN Monothematic Conference
(Lippincott Williams & Wilkins, 2017) Mclin, Valerie A.; Allen, Upton; Boyer, Olivia; Bucuvalas, John; Colledan, Michele; Cuturi, Maria-Cristina; d'Antiga, Lorenzo; Debray, Dominique; Dezsofi, Antal; de Goyet, Jean de Ville; Dhawan, Anil; Durmaz, Ozlem; Falk, Christine; Feng, Sandy; Fischler, Bjorn; Franchi-Abella, Stephanie; Frauca, Esteban; Ganschow, Rainer; Gottschalk, Stephen; Hadzic, Nedim; Hierro, Loreto; Horslen, Simon; Hubscher, Stefan; Karam, Vincent; Kelly, Deirdre; Maecker-Kolhoff, Britta; Mazariegos, George; McKiernan, Patrick; Melk, Anette; Nobili, Valerio; Ozgenc, Funda; Reding, Raymond; Sciveres, Marco; Sharif, Khalid; Socha, Piotr; Toso, Christian; Vajro, Pietro; Verma, Anita; Wildhaber, Barbara E.; Baumann, Ulrich
As pediatric liver transplantation comes of age, experts gathered to discuss current paradigms and define gaps in knowledge warranting research to further improve patient and graft outcomes. Identified areas ripe for collaborative research include understanding the molecular and cellular mechanisms of tolerance and the role of donor-specific antibodies, considering ways to expand donor pool, minimizing long-term side effects of immunosuppression, and fine-tuning surgical techniques to minimize biliary and vascular complications.
Effect of Short-term Probiotic Yogurt Consumption on Caries Risk Factors in Infants
(Galenos Yayincilik, 2019) Eden, Ece; Ak, Asli Topaloglu; Ozgenc, Funda; Aksu, Guzide; Ergin, Ecem
Aim: We aimed to evaluate the effect of short-term probiotic yogurt consumption on pH, buffering capacity, and Streptococcus Mutans, Lactobacilli and secretory immunoglobulin A (sIgA) levels in saliva of 6-8 months old healthy infants. Materials and Methods: Twenty healthy infants and their mothers were enrolled in the study. They were randomly allocated into two groups as study and control. In the study group, probiotic yogurt (Bifidobacterium Longum BB536, Bifidobacterium Bifidum Bb12, Lactobacillus Rhamnosus HN001) was given to infants for 3 weeks whereas, in the control group, home-made yogurt was consumed. A dental saliva pH-Indicator strip (GC, Japan) was used for salivary pH measurements. Buffering capacity was determined using CRT buffer (Ivoclar Vivadent, Liechtenstein). The counts of salivary mutans streptococci and lactobacilli were evaluated using CRT bacteria (Ivoclar Vivadent, Liechtenstein). ELISA was used for sIgA. Scores at baseline and three weeks after were statistically evaluated by Wilcoxon test using the IBM SPSS 20.0 program. Results: Salivary pH, IgA, S. mutans and lactobacilli values showed no significant change after 3 weeks of probiotic yogurt consumption, however there was a statistically significant increase in the buffering capacity of saliva (p= 0.04). Conclusion: Short-term probiotic yogurt intervention in infants during the early stages of life might have benefits for oral health. Further studies with both short- and long-term use of probiotics must be implemented in infants to confirm the results and see the effects on other caries risk factors.
Efficacy and safety of long-term thiopurine maintenance treatment for ulcerative colitis in Turkey: A single-center experience
(Aves, 2018) Ozgenc, Funda; Karakoyun, Miray; Ecevit, Cigdem; Hekimci, Hamiyet; Tasci, Ezgi Kiran; Erdemir, Gulin
Background/Aims: Thiopurines are widely used in the treatment of inflammatory bowel disease, but data are limited. Or aim was to determine the outcome of thiopurine application in children diagnosed with ulcerative colitis (UC). Materials and Methods: Forty-eight patients with UC, diagnosed at our center between 2005 and 2016 and applied azathiopurine (AZA), were included in the study. Data were collected retrospectively. The diagnosis of UC was based on the conventional clinical, radiological, histological, and endoscopic assessment. All patients with UC at this intercept were analyzed at the 4- and 6-week and 3-month intervals after remission to determine patient characteristics, thiopurine properties, and its efficacy and toxicity. Determination of remission, relapse, and steroid refractoriness/dependency were guided according to the European Crohn's and Colitis Organisation consensus. Results: Azathiopurine was started at the median 1 month (0-12 months), and it was applied thereafter for maintenance (n=43). Response to remission induction was obtained in 40 (93.7%) patients. The median duration of the AZA treatment was 24 months (5-63). In 34 (85%) of the 40 children, it was well tolerated until the last visit. During the follow-up, adverse events occurred in 6 patients. These are leucopenia, neutropenia, vomiting, diarrhea, and skin rush. Conclusion: Thiopurine is an appropriate treatment option for remission in patients with UC. For a long-term follow-up, it is very important to identify patients with UC who have clinical remission with side effects and with thiopurine application.
Familial Mediterranean Fever Mutation Analysis in Pediatric Patients With Inflammatory Bowel Disease: A Multicenter Study
(Aves, 2021) Urganci, Nafiye; Ozgenc, Funda; Kuloglu, Zarife; Yuksekkaya, Hasan; Sari, Sinan; Erkan, Tulay; Onal, Zerrin
Background: the aim of the study was to evaluate familial Mediterranean fever (FMF) mutation analysis in pediatric patients with inflammatory bowel disease (IBD). The relation between MEFV mutations and chronic inflammatory diseases hos been reported previously. Methods: Children with IBD (334 ulcerative colitis (UC), 224 Crohn's disease (CD), 39 indeterminate colitis (IC)) were tested for FMF mutations in this multicenter study. The distribution of mutations according to disease type, histopathological findings, and disease activity indexes was determined. Results: A total of 597 children (mean age: 10.8 +/- 4.6 years, M/F: 1.05) with IBD were included in the study. In this study, 41.9% of the patients had FMF mutations. E148Q was the most common mutation in UC and CD, and M694V in IC (30.5%, 34.5%, 47.1%, respectively). There was a significant difference in terms of endoscopic and histopathological findings according to mutation types (homozygous/heterozygous) in patients with UC (P <.05). There was a statistically significant difference between colonoscopy findings in patients with or without mutations (P=.031, P=.045, respectively). The patients with UC who had mutations had lower Pediatric Ulcerative Colitis Activity Index (PUCAI) scores than the patients without mutations (P=.007). Conclusion: Although FMF mutations are unrelated to CD patients, but observed in UC patients with low PUCAI scores, it was established that mutations do not hove a high impact on inflammatory response and clinical outcome of the disease.
Gastroesophageal reflux in children with functional constipation
(Turkish Soc Gastroenterology, 2012) Baran, Masallah; Ozgenc, Funda; Arikan, Cigdem; Cakir, Murat; Ecevit, Cigdem Omur; Aydogdu, Sema; Yagci, Rasit Vural
Background/aims: Functional constipation and gastroesophageal reflux disease are two major and commonly encountered components of childhood functional gastrointestinal disorders. Epidemiological studies in, the adult population support that there is a significant overlap between the different functional disorders of the digestive tract. Therefore, we aimed to investigate the frequency of gastroesophageal reflux disease in children with functional constipation and to compare clinical findings and 24-h esophageal pH monitoring with a group of patients with suspected gastroesophageal reflux disease. Materials and Methods: Children between 4 and 16 years old with functional constipation (based on Rome III criteria, Group 1; n=38) were prospectively evaluated. A control group was composed of patients with symptoms suggesting gastroesophageal reflux disease (Group 2; n= 40). All patients included in the study were asked about reflux-related symptoms, and then all cases underwent 24-h esophageal pH monitoring analysis. Results: Delayed gastric emptying symptoms such as belching and hiccups were more common in patients in. Group 1 (p=0.002, p=0.021, respectively), whereas chronic cough was more common in patients in Group 2 (p=0.012). According to the 24-h esophageal pH monitoring, pathologic acid reflux in the lower and/or laryngopharyngeal portion of the esophagus was determined in 39.5% of the patients in Group 1 and in 42.5% of the patients in Group 2 (p=0.96). No significant difference was found in terms of age, gender and duration of constipation in patients with and without acid reflux in Group 1 patients. Pyrosis (66.6 vs. 0%, p=0.00001) was more common in Group 1 patients with acid reflux, but hiccups (20 vs. 69.5%, p=0.007) and belching (33.3 vs. 60.8%, p=0.184) were more common in patients in Group 1 without acid reflux. Conclusions: Gastroesophageal reflux disease should be considered in the treatment and monitoring of patients with functional constipation. Further studies are needed using 24-h pH multi-channel impedance.
Gastroesophageal reflux with children requiring adenotonsillectomy
(Edizioni Minerva Medica, 2021) Tumgor, Gokhan; Midilli, Rasit; Doganavsargil, Basak; Ozgenc, Funda; Arikan, Cigdem; Kirazli, Tayfun; Yagci, Rasit, V
BACKGROUND: Our aim is to determine the incidence of reflux in children older than 3 years requiring adenotonsillectomy and relationship between GER and diagnostic tests. METHODS: Forty-four patients, who were listed for adenoidectomy/tonsillectomy at Pediatric Ear Nose Throat department due to severe hypertrophy, were evaluated for accompanying GER (Group 1). GER was diagnosed as having at least one positive GER test result (including esophagitis or pH monitoring). Twenty children without reflux symptoms were used as healthy control group (Group 2) and LPR was held. RESULTS: Reflux was detected in 32 children requiring adenotonsillectomy (72.7%). LPR score was negative in all patients in Group 2. There was no correlation between pH monitoring and histopathological evaluation of esophagus. There was a correlation between the LPR score and histological esophagitis in the proximal esophagus. CONCLUSIONS: GER was high in patients with adenotonsillary hypertrophy. LPR score and the history of patients are as effective as invasive techniques like pH monitorization and endoscopy in determining GER disease.
Giant cell hepatitis and autoimmune hemolytic anemia after chickenpox
(Aves, 2010) Baran, Masallah; Ozgenc, Funda; Berk, Omer; Gokce, Demir; Kavakli, Kaan; Yilmaz, Funda; Sen, Sait; Yagci, Rasit Vural
Autoimmune hemolytic anemia with giant cell hepatitis is a distinct entity in children. It is usually fatal with progressive liver disease. Immunosuppressive treatment with conventional drugs offers some response; however, it is usually only temporary. Alternative therapeutic options with monoclonals have been reported with promising remission of the disease. We report a case with autoimmune hemolytic anemia+giant cell hepatitis after varicella infection. She was resistant to standard immunosuppressive combinations, and rescue therapy with rituximab was used. Remission was not achieved with the drug and the child died with septic complication.
Infections developing in patients undergoing liver transplantation: Recipients of living donors may be more prone to bacterial/fungal infections
(Aves, 2020) Yamazhan, Tansu; Avsar, Cansu Bulut; Zeytunlu, Murat; Tasbakan, Meltem; Sertoz, Ruchan; Zeytinoglu, Aysin; Ozgenc, Funda
Background/Aims: Despite surgical advances in liver transplantation and effective prophylactic strategies, posttransplant infections are the most important cause of morbidity and mortality. Diagnosis and management of infections because of developing immunosuppression is difficult and adversely affects mortality. This study aimed to review bacterial and fungal infections in patients after liver transplantation and to reveal the resistance rates. Materials and Methods: A total of 107 patients who underwent liver transplantation between January 2017 and February 2018 were evaluated retrospectively with regard to demographic characteristics, causes of transplantation, conditions that may lead to infection, postoperative infections, pathogens, and resistance patterns. Results: of the 107 patients who underwent liver transplantation, 48 (44.8%) had an infection. Bacterial infections were detected in 41% of the patients, and fungal infections were found in 13%. When we compared living and cadaveric transplants in terms of infection development, these rates were found to be 53% and 33%, respectively (p=0.034). No statistically significant results could be obtained when evaluating conditions such as sex, presence of underlying primary disease, Model for End-Stage Liver Disease MELD score, diabetes status, total parenteral nutrition, and risk factors for infection. Conclusion: After liver transplantation, infections are often seen in the first month of the postoperative period. Knowing the most common pathogens and resistance states in this process reduces infection-related deaths by providing appropriate treatment regimens at the right time.
The influence of marginal zinc deficient diet on post-vaccination immune response against hepatitis B in rats
(Wiley, 2006) Ozgenc, Funda; Aksu, Guzide; Kirkpinar, Figen; Altuglu, Imre; Coker, Isil; Kutukculer, Necil; Yagci, Rasit Vural
Aim: To evaluate in vitro T lymphocyte proliferation and specific antibody response to hepatitis B vaccination in two groups of rats fed with normal and marginal zinc content. Methods: Twenty-two Wistar-Albino rats were randomly assigned into two groups and were fed with constant diet. Zinc was suplemented 10 mg/kg dry weight in group I (marginal zinc content) (n = 14) and 30 mg/kg dry weight in group II (n = 8). Hepatitis B vaccine (Engerix B, 4 mu g) was administered intramuscularly after 8 weeks on feeding and a booster dose was applied 4 weeks after the first injection. Rats were killed 3 weeks after the second injection. Peripheral blood mononuclear cells were stimulated in vitro by PHA (2.5 mu g/ml) and hepatitis B surface antigen (2.5, 5, 10 mu g/ml). Proliferation was evaluated by ELISA (celltiter-96 aqueous one solution cell proliferation assay). Serum zinc, anti-HBs titer and zinc per dry liver weight were also measured. Two groups were compared with respect to antigen specific antibody and lymphocyte proliferation responses. Proliferation response to HbsAg were expressed as net percent increase (pci) in lymphocyte proliferation from the baseline activity. Results: Rats' mean body weight and weight gain per month were similar. Median serum zinc was 39 (23-75) and 76 (64-115) mu g/dl of groups I and 11 rats, respectively (p < 0.05), while there was no difference in liver zinc content between the two groups (37 mu g/g dry weight versus 32 mu g/g dry weight). Median anti-HBs levels of groups I and II were 741 (0-10,000) IU/l, 5791 (558-10,000) IU/l, respectively (P < 0.05). In lymphocyte proliferation assays, mean net pci with HbsAg of 5 and 10 mu g/ml were 9.4% and 11.3% in group I rats; while they were 25.3% and 26.1% in group 11 rats (p < 0.01 and p < 0.01, respectively). Conclusion: In vitro cell-mediated immune response and in vivo specific antibody response to hepatitis B vaccine was decreased in rats fed a diet with marginal zinc content. These observations have shown that marginal Zn deficiency might influence the efficacy of hepatitis B vaccination in humans. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
INVISIBLE INGESTED FOREIGN BODY: ALUMINUM CAN TOP
(Elsevier Science Inc, 2014) Saz, Eylem Ulas; Ozen, Selime; Ecevit, Cigdem Omur; Ozgenc, Funda
Long-Term Effect of Gluten-Free Diet on Growth Velocity in Turkish Children with Celiac Disease
(Springer, 2009) Aydogdu, Sema; Midyat, Levent; Cakir, Murat; Tumgor, Gokhan; Yuksekkaya, Hasan Ali; Baran, Masallah; Arikan, Cigdem; Ozgenc, Funda; Yagci, Rasit Vural
We sought to analyze the long-term growth in children with celiac disease (CD) as well as the association of height and weight SD score at the end of 4 years with the demographic and clinical presentation at initial admission. Thirty-four children with CD were enrolled in the study and followed for at least 4 years. Patients were divided into three groups (Group 1: patients a parts per thousand currency sign5 years old, Group 2: patients 5-10 years old, and Group 3: patients > 10 years, at the time of diagnosis). Patients' charts were reviewed for demographic and clinical features at initial admission. Anthropometric measurements at initial admission, at 6th months, and 1st, 2nd, 3rd, and 4th years were recorded. Gluten-free diet led to rapid increase in weight SD and height SD score in patients a parts per thousand currency sign5 years old at the time of diagnosis (Group 1). Increment in height SD score was the highest in patients 5-10 years old (Group 2) at the end of 4 years. A negative correlation was found between age at the time of diagnosis and weight and height SD score at the end of 4 years (r = -0.503, P = 0.03 and r = -0.554, P = 0.01). Multiple regression analysis revealed that height SD score at the end of the 4 years was associated with age at the time of diagnosis. The other factors had no effect on the weight and height SD score at the end of 4 years. Early diagnosis and good adhesion to a gluten-free diet are essential for long-term growth in CD. Celiac societies and the mass media must expand an effort to educate the community regarding the symptoms of the disease.
Long-Term Effect of Gluten-Free Diet on Growth Velocity in Turkish Children with Celiac Disease
(Springer, 2009) Aydogdu, Sema; Midyat, Levent; Cakir, Murat; Tumgor, Gokhan; Yuksekkaya, Hasan Ali; Baran, Masallah; Arikan, Cigdem; Ozgenc, Funda; Yagci, Rasit Vural
We sought to analyze the long-term growth in children with celiac disease (CD) as well as the association of height and weight SD score at the end of 4 years with the demographic and clinical presentation at initial admission. Thirty-four children with CD were enrolled in the study and followed for at least 4 years. Patients were divided into three groups (Group 1: patients a parts per thousand currency sign5 years old, Group 2: patients 5-10 years old, and Group 3: patients > 10 years, at the time of diagnosis). Patients' charts were reviewed for demographic and clinical features at initial admission. Anthropometric measurements at initial admission, at 6th months, and 1st, 2nd, 3rd, and 4th years were recorded. Gluten-free diet led to rapid increase in weight SD and height SD score in patients a parts per thousand currency sign5 years old at the time of diagnosis (Group 1). Increment in height SD score was the highest in patients 5-10 years old (Group 2) at the end of 4 years. A negative correlation was found between age at the time of diagnosis and weight and height SD score at the end of 4 years (r = -0.503, P = 0.03 and r = -0.554, P = 0.01). Multiple regression analysis revealed that height SD score at the end of the 4 years was associated with age at the time of diagnosis. The other factors had no effect on the weight and height SD score at the end of 4 years. Early diagnosis and good adhesion to a gluten-free diet are essential for long-term growth in CD. Celiac societies and the mass media must expand an effort to educate the community regarding the symptoms of the disease.
Peptic ulcer disease in children: An uncommon disorder with subtle symptomatology
(Turkish Soc Gastroenterology, 2012) Ecevit, Cigdem Omur; Ozgenc, Funda; Yuksekkaya, Hasan Ali; Unal, Fatih; Arikan, Cigdem; Yagci, Rasit Vural
Background/aims: Data concerning peptic and infectious ulcers in children are limited. The aim of the study was to investigate the prevalence, presenting symptoms and significance of symptomatology in ulcer diagnosis in the pediatric age group. Materials and Methods: Between January 2000 and 2009, upper gastrointestinal endoscopy charts were examined retrospectively. All children in whom a diagnosis of ulcer was established were included in the study. Demographic, clinical, endoscopic, and histopathologic data were obtained from the patients' records. Peptic ulcer disease prevalence, presenting symptoms and symptomatology were evaluated. Results: Ulcer disease was observed in 31 (3.4%) of 902 patients. The mean age was 10.85 +/- 4.25 (range: 2-17 years), and the male to female ratio was 2:1. The most common symptom was chronic abdominal pain (68%), hematemesis and melena (55%) and vomiting (39%). Helicobacter pylori was identified in 19 patients (61%) with ulcer. In the Helicobacter pylori-positive group, upper intestinal bleeding and pain were the major symptoms. Symptom frequency was not different between Helicobacter pylori-positive and -negative patients (p>0.05). Conclusions: Ulcer disease is an uncommon disorder in children with nonspecific clinical symptoms. Unlike the adult population, symptoms fail to diagnose peptic ulcer disease before gastrointestinal bleeding occurs.
Post-transplant malignancies in pediatric liver transplant recipients: Experience of two centers in Turkey
(Aves, 2018) Karakoyun, Miray; Onen, Sebnem; Baran, Masallah; Cakir, Murat; Ecevit, Cigdem Omur; Kilic, Murat; Kantar, Mehmet; Aksoylar, Serap; Ozgenc, Funda; Aydogdu, Sema
Background/Aims: A liver transplant is the preferred treatment for patients with end-stage liver disease, as it usually results in long-term survival. However, due to the use of chronic immunosuppressive therapy, which is necessary to prevent rejection, de novo cancer is a major risk after transplantation. The aim of this study was to assess the incidence of post-transplant malignancies in children after liver transplantations. Materials and Methods: The study group consisted of 206 liver transplant recipients, with no history of cancer, including hepatocellular carcinoma, in two liver transplantation centers in Turkey between 1997 and 2015. Data were obtained from patient's data chart. Results: In the study group, de novo cancer was diagnosed in 13 of the 206 patients. Post-transplant lymphoproliferative disease (PTLD) occurred in seven (53.8%) patients and other malignancies in six of the 13 patients. The types of PTLD were as follows: B-cell origin (n= 2), Epstein-Barr virus (EBV)-related (n= 2), T-cell origin (n= 1), and Hodgkin's lymphoma (n= 2). EBV DNA was isolated from seven patients, three of whom developed PTLD. The others developed Kaposi's sarcomas, Burkitt's lymphomas, cutaneous large-cell lymphomas, Hodgkin's lymphomas, and liver sarcomas. Conclusion: After transplantation, immunosuppressive treatment is unavoidable, increasing the risk of malignancies. However, a close follow-up and periodic screening can reduce cancer-related mortality and morbidity.
Prevelance of hepatitis D co-enfection in children with hepatitis B infection: Cross-sectional analyses from Western Turkey
(Aves, 2013) Ozgenc, Funda; Ecevit, Cigdem Omur; Erdemir, Gulin; Sertoz, Ruchan; Yagci, Rasit Vural
Background/aims: Effective hepatitis B virus control has warranted a decline in hepatitis B virus prevalence over the world with a relevant reduction in hepatitis B virus-associated delta hepatitis. However, despite the dramatic decline in hepatitis D virus infection rate, no further decrease was recorded after 2000. This cross-sectional study aims to investigate: I- The prevalence of hepatitis D virus co-infection in children with hepatitis B virus infection in Western Turkey; II- The influence of neonatal hepatitis B virus vaccination on hepatitis D virus co-infection rate; and III- The impact of co-infection on prognosis of liver disease. Materials and Methods: Serological markers of hepatitis B virus and hepatitis D virus infections were determined by ELISA in patients with chronic hepatitis during immune tolerance, immunoactive, HBeAg-negative chronic, and inactive carrier state. Delta co-infection rate was evaluated in two groups, children born before and after the national neonatal mass vaccination has started (before and after 2000). Viral load, serum alanine aminotransferase, and histological grade were evaluated in co-infected cases. Results: Overall hepatitis delta virus infection rate was 1,76% (3/170); two patients with eAg-negative chronic hepatitis B and one patient in the immunoactive phase were infected with hepatitis D virus. Mean fibrosis score of hepatitis D virus -infected cases and hepatitis B virus -infected counterparts were 4 +/- 1,7 and 1,3 +/- 1, respectively (p: 0,006). Hepatitis D virus infection was detected in 2 out of 158 children born before and in 1 of 12 born after the neonatal vaccination program. Hepatitis B e-antibody was detected in two patients with delta co-infection (11 and 6 years old), and all mothers of delta hepatitis cases were chronically hepatitis B virus-infected. Conclusions: Delta hepatitis is rare among hepatitis B virus-infected children in the Western region of Turkey. Despite the success of the national vaccination program, delta hepatitis is not a vanishing disease and it has a grave prognosis due to development of early cirrhosis.
A rare complication of central catheter in an infant with intestinal failure
(Karger, 2008) Cakir, Murat; Levent, Erturk; Yuksekkaya, Hasan Ali; Ergun, Orkan; Ozgenc, Funda; Yagci, Rasit Vural
Objective: To report the successful percutaneous transcatheter removal of a snapped intracardiac fragment of the central vein catheter in an infant. Clinical Presentation and Intervention: A 3-month-old infant with short bowel syndrome who required long-term parenteral nutrition via portacath central catheter was hospitalized. Two months after the insertion of the second catheter, the distal tip of the catheter snapped and became tangled in the heart. The catheter fragment was removed by a percutaneous femoral vein approach using a 10-mm diameter snare-loop catheter (Amplatz (R)). The procedure was performed under fluoroscopy; the fragment was removed after being released into the right ventricle by pulling the proximal tip with a pigtail catheter. No complications were observed and the patient was transported back to the intensive unit in stable condition. Conclusion: Central catheter-related complications may cause difficulties in patients with short bowel syndrome prior to intestinal transplantation. The percutaneous retrieval of the fragmented catheter using a snare-loop catheter is a safe and reliable technique and may be used instead of surgery especially in small infants. Copyright (C) 2008 S. Karger AG, Basel.

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