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Mechanical lithotripsy and/or stenting in management of difficult common bile duct stones

Hepatobiliary & Pancreatic Diseases International 2009年第5期8卷 524-528页

作者： Adem Akcakaya orhan Veli Ozkan Gurhan Bas Atilla Karakelleoglu orhan kocaman Ismail Okan Mustafa Sahin First Department of General Surgery Vakif Gureba Training and Research Hospital34280 IstanbulTurkey Faculty of Medicine Department of General SurgeryMustafa Kemal University 31100 HatayTurkey Faculty of Medicine Department of GastroenterologyKocaeli University41760 KocaeliTurkey

BACKGROUND:Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP)*** study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP. METHODS:Between 2000 and 2008,744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy *** demographic features,and clinical and laboratory findings were collected from a prospectively held *** duct calculi were extracted by basket and/or balloon catheter following ERCP and *** with retained stones were regarded as difficult *** patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement. RESULTS:Two hundred and forty-five patients(41%) were male and 347(59%)were female with a mean age of 58 years(range 19-95 years).Stones were impacted in 27 patients(5%).Stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures,and lithotripsy was performed in 70 ERCP ***- four patients underwent stent insertion,and 20 underwent stent *** occurred in 39 patients (5%),with no mortality associated with the *** occurred in 9 patients and basket impaction in *** pancreatitis and cholangitis developed in 12 and 11 patients,respectively. CONCLUSION:Difficult cases of bile duct stones can be treated successfully with lithotripsy,and a stent should be applied when the common bile duct cannot be cleared completely.

关键词： common bile duct stone endoscopic retrograde cholangiopancreatography stone extraction mechanical lithotripsy stenting

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Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

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World Journal of Gastroenterology 2009年第29期15卷 3649-3652页

作者： Adem Akcakaya orhan Veli Ozkan Ismail Okan orhan kocaman Mustafa Sahin 1st Department of General Surgery Vakif Gureba Research and Training Hospital 34093 Istanbul Turkey Department of General Surgery Faculty of Medicine Mustafa Kemal University 31100 Hatay Turkey Gastroenterology Division of Medical Faculty Hospital Kocaeli University 41380 Kocaeli Turkey

AIM： To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography （ERCP） without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS： Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCI and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS： The mean age of the patients was 28 years （range, 21-33 years）. The mean gestational age for the fetus was 23 wk （range, 14-34 wk）. Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION： Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree.

关键词： Cholangitis Choledocholithiasis Endoscopic retrograde cholangiopancreatography Jaundice Pregnancy

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Clindamycin-induced acute cholestatic hepatitis

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World Journal of Gastroenterology 2007年第40期13卷 5408-5410页

作者： Cem Aygün orhan kocaman Yesim Gürbüz mer Sentürk Sadettin Hülagü Department of Gastroenterology Pathology Kocaeli University Medical FacultyKocaeli 41380Turkey

We report a case of acute hepatotoxicity in a 42-yearold woman after administration of clindamycin for a dental infection. After 6 d of treatment, she had fatigue, nausea, vomiting, anorexia, pruritus and jaundice. Her laboratory analysis showed alanine aminotransferase （ALT）, 1795 IU/L （normal range 0-40）; aspartate aminotransferase （AST）, 1337 IU/L （normal range 5-34）; alkaline phosphatase （ALP）, 339 IU/L （normal range 40-150）; 7-glutamyl transpeptidase （GGT）, 148 IU/L （normal range 9-64 IU/L）; total bilirubin, 4.1 mg/dL; direct bilirubin, 2.9 mg/dL and prothrombin time （PT）, 13.5 s, with international normalized ratio （INR）, 1.04. She was hospitalized, with immediate drug discontinuation. Her liver biopsy specimen showed mixed-type （both hepatocellular and cholestatic） hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that clindamycin was the probable cause of the acute hepatitis. In susceptible individuals, clindamycin use may lead to acute mixedtype liver toxicity. Complete recovery may be possible if the drug is discontinued before severe liver injury is established.

关键词： Clindamycin Hepatic injury Hepatitis

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Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

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World Journal of Gastroenterology 2011年第13期17卷 1701-1709页

作者： Sadettin Hulagu Omer Senturk Cem Aygun orhan kocaman Altay Celebi Tolga Konduk Deniz Koc Goktug Sirin Ugur Korkmaz Ali Erkan Duman Neslihan Bozkurt Gokhan Dindar Tan Attila Yesim Gurbuz orhan TarcinDivision of Gastroenterology Derince State Hospital Kocaeli 41900 Turkey Cem Kalayci Division of Gastroenterology Kocaeli University Medical School Kocaeli 41000 Turkey Division of Gastroenterology American HospitalIstanbul 34365 Turkey Department of Pathology Kocaeli UniversityMedical School Kocaeli 41000 Turkey Division of Gastroenterology Marmara University School of Medicine Altunizade Istanbul 34662 Turkey

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

关键词： Endoscopic submucosal dissection Premalignant gastrointestinal lesion Noninvasive early gastrointestinal cancer Neuroendocrine tumor Gastrointestinal stromal tumor

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A Hybrid Multi-Hazard Susceptibility Assessment Model for a Basin in Elazig Province,Türkiye

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International Journal of Disaster Risk Science 2023年第2期14卷 326-341页

作者： Gizem Karakas Sultan kocaman Candan Gokceoglu Graduate School of Science and Engineering Hacettepe University06800BeytepeAnkaraTurkey Department of Geomatics Engineering Hacettepe University06800BeytepeAnkaraTurkey Department of Geological Engineering Hacettepe University06800BeytepeAnkaraTurkey

Preparation of accurate and up-to-date susceptibility maps at the regional scale is mandatory for disaster mitigation,site selection,and planning in areas prone to multiple natural *** this study,we proposed a novel multi-hazard susceptibility assessment approach that combines expert-based and supervised machine learning methods for landslide,flood,and earthquake hazard assessments for a basin in Elazig Province,Tü*** produce the landslide susceptibility map,an ensemble machine learning algorithm,random forest,was chosen because of its known performance in similar *** modified analytical hierarchical process method was used to produce the flood susceptibility map by using factor scores that were defined specifically for the area in the *** seismic hazard was assessed using ground motion parameters based on Arias intensity *** univariate maps were synthesized with a Mamdani fuzzy inference system using membership functions designated by *** results show that the random forest provided an overall accuracy of 92.3%for landslide susceptibility *** the study area,41.24%were found prone to multi-hazards(probability value>50%),but the southern parts of the study area are more *** proposed model is suitable for multi-hazard susceptibility assessment at a regional scale although expert intervention may be required for optimizing the algorithms.

关键词： Earthquakes Floods Fuzzy inference systems Landslides Multi-hazard susceptibility assessment Random forest Türkiye

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