Ayse Dursun

Efficacy and Safety of Saccharomyces boulardii in the 14-day Triple Anti-Helicobacter pylori Therapy: A Prospective Randomized Placebo-Controlled Double-Blind Study

Background:  Recent studies indicate a potential role of Saccharomyces boulardii in the prevention of Helicobacter pylori treatment‐related side‐effects and also in improvement of eradication rate. Our aim is to investigate the efficacy and safety of S. boulardii in the prevention of side‐effects related to H. pylori eradication. The secondary aim of the study was to define the effect of S. boulardii on the eradication success of anti‐H. pylori therapy.

Double-blinded, randomized, placebo-controlled study to evaluate the effectiveness of sulphasalazine in preventing acute gastrointestinal complications due to radiotherapy

BACKGROUND AND PURPOSE Acute radiation-induced diarrhea occurs in approximately 80% of the patients receiving pelvic radiotherapy. It is caused by gastrointestinal irritation and inflammation. Eicosanoids are thought to be one of the mechanisms of this. Sulphasalazine is an inhibitor of their synthesis in the mucosa. This randomized clinical trial was undertaken to evaluate its effect in preventing acute radiation enteritis (ARE). MATERIALS AND METHODS Prospectively, 87 patients receiving pelvic radiotherapy were randomized, in a double-blind fashion. Two tablets twice daily of sulphasalazine (500 mg) or placebo were administered orally. Patients were evaluated weekly according to diarrhea grading for the primary study endpoint and according to late effect of normal tissue-subjective objective management analytic (LENT-SOMA) criteria for the secondary endpoint during irradiation. RESULTS Groups did not differ for age, gender, tumour site or irradiation procedure. Diarrhea occurred in 55 and 86% of the sulphasalazine and placebo groups, respectively (P=0.001). Gastrointestinal toxicity was seen in 80 and 93% of the sulphasalazine and placebo groups according to the maximum LENT-SOMA score (P=0.07). According to the maximum LENT-SOMA score between the two groups, significant differences in favor of sulphasalazine were found for each week. CONCLUSION Sulphasalazine (2 g/day) was found to be effective in decreasing the symptoms of ARE.

Expression of MUC1 and MUC2 mucins in gastric carcinomas: Their relationship with clinicopathologic parameters and prognosis

The aim of this study was to investigate the relationship between MUC1 and MUC2 mucin expressions and clinicopathologic variables in gastric carcinomas with regard to survival times. MUC1 and MUC2 expressions were revealed immunohistochemically in 143 gastric carcinomas. Of these 143 patients, follow-up data were available for 45 (median survival time of 30 months, ranging from 2 to 80 months). MUC1 was detected in 82 (58%), and MUC2 in 60 (42%) out of 143 cases. Papillary adenocarcinomas showed significantly higher MUC1 and MUC2 immunoreactivity than did signet-ring cell and mucinous tumors (p = 0.045 and p = 0.01, respectively). MUC1 was highly positive in intestinal-type carcinomas (p = 0.006), whereas intestinal and diffuse carcinomas did not differ in MUC2 expression. There was a positive correlation between tumor differentiation and MUC1 expression. However, no correlation was found between MUC1 and MUC2 expressions and angiolymphatic invasion. According to the TNM classification, stage 1A tumors have significantly lower rates of MUC1 reactivity compared to higher stages (p = 0.04). The patients with gastric carcinomas expressing MUC1 showed significantly poorer survival than those without MUC1 expression (p = 0.04). The present study suggests that MUC1 expression be a useful prognostic factor for predicting the outcome of gastric carcinoma patients, whereas the role of MUC2 expression is still unclear.

Increased Colonic Intraepithelial Lymphocytes in Patients With Hashimoto's Thyroiditis

Background Hashimotos thyroiditis is an autoimmune thyroid disorder. Lymphocytic colitis and collagenous colitis are characterized by diarrhea with normal endoscopic findings. Autoimmune disorders are common in Hashimotos thyroiditis and lymphocytic colitis. The aim of this study was to investigate the incidence of lymphocytic colitis in patients with Hashimotos thyroiditis. Study Fifty patients with well-documented Hashimotos thyroiditis were included. Twenty patients with nonulcer dyspepsia served as a control group. Five of 50 patients with Hashimotos thyroiditis reported intermittent diarrhea, whereas no patients had diarrhea in the control group. All patients and the control group underwent total colonoscopy, and multiple colonoscopic biopsies were performed. Results We found that 40% (20 of 50) of Patients with Hashimotos thyroiditis had histologic findings consistent with lymphocytic colitis, and one patient in the control group had lymphocytic colitis (p < 0.01). The mean number of intraepithelial lymphocytes was 34.4/100 epithelial cells in these 20 patients, whereas the mean number of intraepithelial lymphocytes was 12.3/100 epithelial cells in the other 30 patients with Hashimotos thyroiditis (p < 0.05). Conclusions There was a higher incidence of histologic findings of lymphocytic colitis in patients with Hashimotos thyroiditis, although most of the patients were clinically asymptomatic. This finding suggests that lymphocytic colitis may have an asymptomatic clinical course and should encourage further clinical investigations to better anticipate the relationship between autoimmune disorders.

Angiogenesis, p53, and bcl-2 expression as prognostic indicators in endometrial cancer: Comparison with traditional clinicopathologic variables

&NA; We investigated the relation of expression of tumor‐suppressor gene product p53, apoptosis‐regulator gene product bcl‐2, and CD34 (as a measure of microvessel density [MVD]) with traditional clinicopathologic prognostic variables in endometrial carcinoma (histologic type, grade, depth of myometrial invasion, angiolymphatic invasion, lymph node involvement). In specimens from 63 patients with endometrial carcinoma, the mean MVD (64.38±28.71 microvessels per 200× field) was not related to any clinicopathologic variables. Nuclear p53 expression was detected in 15 (23.8%) patients and was higher in nonendometrioid carcinomas (p<0.05) and in tumors with increasing histologic grade (p<0.001). Cytoplasmic bcl‐2 staining was seen in 79.3% of the tumors. There was a negative correlation between bcl‐2 expression and histologic type and tumor grade (p<0.05). In survival analysis, patient age, FIGO stage, high expression of p53, low expression of bcl‐2, and high and intermediate MVD values were found to be the most significant prognostic indicators of survival (p<0.05). In multivariate regression analysis, FIGO stage and low bcl‐2 expression were found to be the only independent indicators of prognosis (p<0.05).

Comparison of Consequent Small Bowel Anastomoses After Transient Ischemia: An Experimental Study in Rats

BACKGROUND/PURPOSE The role of ischemia/reperfusion (I/R) damage on intestinal anastomotic healing remains to be precisely determined. The objective of this study was to investigate healing of small bowel anastomoses performed at different times after transient ischemia. METHODS Thirty male Wistar-Albino rats were investigated in five groups (four study and one control). Under general anesthesia, the superior mesenteric artery (SMA) was occluded for 40 minutes in the study rats. Biopsy specimens, to document I/R histopathology, were obtained before small intestinal anastomoses at 20 minutes (group 1), 90 minutes (group 2), 6 hours (group 3), and 24 hours (group 4) after reperfusion. In a control group, biopsy and intestinal anastomoses were performed after SMA dissection without occlusion. The rats were relaparotomized on the fifth day to determine in situ bursting pressures and to obtain specimens for hydroxyproline content and histopathologic evaluation. RESULTS Hydroxyproline content and bursting pressures were compared statistically with Mann-Whitney U test. Although there was no statistical difference between the control group and group 1, there were significant differences (P < .05) between groups 2, 3, and 4, with both parameters decreasing as the duration after reperfusion increased. CONCLUSION Anastomosis are less likely to leak when performed sooner rather than later after an ischemia/reperfusion event.

Cyclooxygenase-2 expression and its association with angiogenesis, Helicobacter pylori, and clinicopathologic characteristics of gastric carcinoma

Cyclooxygenase-2 (COX-2) is upregulated in gastric carcinoma, and its increased levels were found to have a prognostic significance in some studies. Both angiogenesis and Helicobacter pylori infection have been reported to be associated with COX-2 expression of gastric cancer in recent studies. In this study, COX-2 expression and its association with CD31 staining, H.-pylori infection, and well-known clinicopathological factors were investigated in 65 gastric cancer patients. COX-2 and CD31 expression assessment was done by immunohistochemical methods. Whartin Starry stain was performed for H.-pylori infection. Of 65 patients, 32 (49%) revealed intense COX-2 immunostaining. Among various clinicopathologic characteristics, COX-2 expression was inversely correlated with tumor size, TNM stage, and lymph node status. Thirty-two (49%) patients revealed intense CD31 immunostaining. Among various clinicopathologic characteristics, CD31 expression was associated only with lymph node metastasis. COX-2 expression was not correlated with CD31 staining and H.-pylori infection. Both COX-2 and CD31 staining had no prognostic significance. In conclusion, we found that COX-2 expression was significantly higher in earlier stages of gastric cancer. It can be suggested that COX-2 expression may be important in the initial development of gastric cancer but not in progression of the disease. Other factors which may be associated with COX-2 in gastric cancer, including angiogenesis and H.-pylori infection, should be investigated in further studies.

Prognostic implication of nm23-H1 expression in colorectal carcinomas

Aims: Expression of nm23 has been identified as a potential metastatic suppressor. In this study, nm23‐H1 expression, clinicopathological parameters and influences on clinical outcomes were investigated in colorectal carcinoma patients. Methods: Immunostaining was performed on 185 colorectal carcinomas using a polyclonal anti‐nm23‐H1 antibody. Results: The nm23‐H1 immunoreactivity was weak in 31 (17%), moderate in 48 (26%) and strong in 106 (57%) cases. The well differentiated adenocarcinomas showed significantly strong staining for nm23‐H1 compared with the moderately and poorly differentiated adenocarcinomas ( h 2 test, P < 0.001). Advanced tumour stages were associated with reduced nm23‐H1 expression ( P < 0.001). There was an inverse correlation with angiolymphatic invasion, nodal metastasis and liver metastasis (univariate logistic regression analysis, P < 0.001). In univariate analysis, patients with reduced expression of nm23‐H1 had significantly shorter overall and disease‐free survival than the strong expression group (log‐rank test for trend, P = 0.002 and P = 0.003, respectively). Conclusions: Our results indicated that reduced nm23‐H1 expression showed poor prognosis in colorectal carcinomas. As a result, nm23‐H1 expression might be a useful marker to predict outcome while planning treatment.

The rare presentations of a large polyp and an esophageal carcinoma in heterotropic gastric mucosa: a case series

BackgroundHeterotopic gastric mucosa (HGM) is commonly seen in the upper esophagus during endoscopyand is generally considered a benign disease. A hyperplastic polyp and an adenocarcinoma arising in heterotopic gastric mucosa are quite rare occurences.Case presentationsWe present two cases: The first is a patient who suffered from dysphagia because of a large hyperplastic polyp that arose from HGM; the polyp was excised endoscopically. Secondly, we report a rare case of adenocarcinoma arising in HGM of the cervical esophagus.ConclusionMorphologic changes or malignant transformation can develop in the inlet patch. Therefore, gastroenterologists should be aware of the possibility of HGM just distal to the upper esophageal sphincter.

Latent and potential celiac disease in epileptic Turkish children.

In this study, we measured tissue transglutaminase IgA antibody for the serologic screening of celiac disease in 70 children with epilepsy. A pathologic titer of tissue transglutaminase IgA antibody was found in eight patients (4.7%). Small intestinal biopsies were performed in all antibody-positive patients, and two of them had small bowel histology typical of celiac disease (1.17%). Six had normal histology and were considered to have potential celiac disease. The prevalence of celiac disease in the epileptic group was 1.17%. None of the serum samples of 103 healthy children comprising the control group were positive for tissue transglutaminase IgA antibody. Therefore, we suggest that epileptic children be screened for celiac disease. (J Child Neurol 2006;21:6—7).