Elife Erarslan

Association of visceral fat accumulation and adiponectin levels with colorectal neoplasia.

Purpose There are few studies addressing the association between measured values of visceral fat accumulation (VFA), adiponectin, and colorectal neoplasia. Our purpose is to investigate the association of VFA and serum adiponectin levels with colorectal adenoma and carcinoma patients. For this purpose, 54 patients with colorectal adenoma and carcinoma, diagnosed by colonoscopic evaluation, and 50 healthy control subjects were included. Patients were subjected to measurement of VFA and adiponectin level and calculation of insulin resistance. Results Patients with colorectal carcinoma had lower plasma adiponectin levels compared with controls. VFA level did not differ between patients and controls. Adiponectin level was found to be uncorrelated with VFA in the colorectal cancer and adenoma group. No correlation was found between insulin resistance and plasma adiponectin level and VFA. Conclusion Our findings suggest that decreased plasma adiponectin level may be a factor involved in the development of colon cancer or a secondary effect of the metabolic derangements in colorectal cancer.

Mean platelet volume could be possible biomarker in early diagnosis and monitoring of gastric cancer.

Abstract Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC.

Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and mean platelet volume as potential biomarkers for early detection and monitoring of colorectal adenocarcinoma.

Colorectal cancer (CRC) is the third most common cause of cancer-related death in Europe. The aim of the present study was to elucidate the efficiency of the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR), and the mean platelet volume (MPV) as tools for the preoperative diagnosis of CRC and their usefulness in the follow-up of CRC. A total of 144 CRC patients, as diagnosed by colonoscopy, and 143 age-matched and sex-matched healthy participants were included in the study. Medical records were used to compare preoperative and postoperative data including hemoglobin levels, platelet counts, MPV, NLR, and PLR. NLR, PLR, and MPV were significantly higher in CRC patients preoperatively, compared with healthy participants. Receiver-operating characteristic curve analysis suggested 2.02 as the cutoff value for NLR [area under the curve (AUC): 0.921, sensitivity: 86%, specificity: 84%], 135 as the cutoff value for PLR, (AUC: 0.853, sensitivity: 70%, specificity: 90%) and 8.25 fl as the cutoff value for MPV (AUC: 0.717, sensitivity: 54%, specificity: 76%). Subgroup analysis showed that NLR, PLR, and MPV levels were also significantly higher in nonanemic CRC patients compared with the control group, which is of great theoretical and clinical value for the early detection of CRC. Surgical tumor resection resulted in a significant decrease in NLR, PLR, and MPV. Our results suggest that NLR, PLR, and MPV may be used as easily available additional biomarkers for CRC in screening the general population, as well as in postoperative follow-up.

Effects of erdosteine on cyclosporine-A–induced hepatotoxicity in rats

Cyclosporine A (CsA) is a potent immunosuppressive agent used for organ transplantations and various autoimmune disorders. However, hepatotoxicity due to CsA remains one of the major side effects. The use of antioxidants reduces the adverse effects of CsA. The aim of this study was to determine the protective effects of erdosteine on CsA-induced liver injury through tissue oxidant/antioxidant parameters and to evaluate light microscopic alterations in rat-liver tissues. Rats were randomly divided into four experimental groups: The control group received sunflower oil (2 mL/kg/day, per orally; p.o.), while the other groups were treated with CsA (25 mg/kg/day, p.o.) or erdosteine (10 mg/kg/day, p.o.) or CsA+erdosteine, respectively. Serum aspartate aminotransferase and alanine aminotransferase levels, tissue malondialdehyde and nitric oxide levels, and superoxide dismutase, glutathione peroxidase and catalase enzyme activities were measured. Histological examination was performed. CsA caused a significant deterioration in the hepatic function tests, morphology, and gave rise to severe oxidative stress in the liver. Erdostein significantly improved the functional and histological parameters and attenuated the oxidative stresss induced by CsA. Erdostein protects liver tissue against oxygen free radicals and prevents hepatic dysfunction and morphological abnormalities associated with chronic CsA administration.

IGF-I levels and visceral fat accumulation in colonic neoplasia

BACKGROUND IGF-I, visceral obesity, IGF binding protein-3 and insulin are reported to be potential risk factors for colorectal carcinogenesis. Many studies report a relation between obesity, insulin resistance and the risk of colon cancer. This study investigates the association between IGF-I levels, insulin resistance and visceral fat accumulation in patients with colon cancer and adenoma. METHODS In this cross sectional study, 48 sequential patients were diagnosed with either colorectal adenoma or carcinoma were enrolled. The control subjects were 30 sequential subjects. Serum IGF-I, HOMA insulin resistance index and visceral fat were measured in patients with colorectal adenoma and carcinoma. RESULTS Serum IGF-I levels were significantly higher in patients with colorectal adenoma and carcinoma compared with controls. Visceral fat accumulation was lower in colorectal carcinoma group compared with colorectal adenoma group, but no statistically significant difference was observed among them and controls. No statistically significant difference was observed in HOMA insulin resistance index, fasting insulin and fasting glucose concentrations among the three groups. No correlation was found between insulin resistance and serum IGF-I levels and visceral fat accumulation. Logistic regression analysis showed that plasma IGF-I concentration was significantly associated with colorectal adenoma and carcinoma. Body mass index and waist circumference were associated with colorectal, carcinoma but were not associated with adenoma. CONCLUSION In our study we found that, IGF-I levels are associated with colorectal adenomas and carcinomas, independent of insulin resistance and visceral fat accumulation; supporting the hypothesis that an increase in IGF-I levels may be a factor involved in the development of colon cancer.

Unusual cause of acute gastrointestinal bleeding: gastric pyogenic granuloma.

Pyogenic granuloma (PG) is a benign, polypoid type of lobular capillary hemangioma that presents as a polypoid red mass. The lesion is found most commonly on the skin and in the oral cavity. It is extremely rare in the alimentary tract, other than in the oral cavity. Here, we report a case of PG identified in the stomach associated with acute bleeding. A 64-year-old man was admitted to our emergency room with a complaint of hematemesis and melena. Physical examination revealed no remarkable abnormalities other than conjunctival paleness.At the time of admission his laboratory findings were as follows: hemoglobin 10 g/dL, hematocrit 28.5%. An upper gastrointestinal endoscopy revealed a pedunculated reddish lesion approximately 8 mm in diameter with an irregular surface in the cardia of the stomach. Blood was leaking from the surface of the lesion (Fig. 1). The lesion was resected using a polypectomy snare. Histological examination of the resected specimen revealed many capillaries of various sizes, lined with plump endothelial cells, accompanied by acute and chronic inflammatory infiltrates. The endothelial cells proved to be immunohistochemically positive for CD34 (Fig. 2).The histological features were consistent with those of a PG. No bleeding was noted following endoscopic resection of the lesion. Anemia was resolved by treating with iron. PG is an acquired benign tumor arising from the blood vessels of the skin or mucosa, polypoid form of capillary hemangioma.To date, a few cases of PG of the digestive tract have been reported, particularly in the colon, ileum, and esophagus. Only two cases have been described in the stomach. To our knowledge, this is the second case report of gastric PG presenting with acute gastrointestinal bleeding. In conclusion, PG should be considered in the differential diagnosis of acute gastrointestinal bleeding.

Serum m 30 levels reflects ulcerative colitis activity.

Background:Apoptosis plays a role in epithelial and mucosal injury, which is 1 of the mechanisms in the pathogenesis of ulcerative colitis. Apoptotic cells increase as a result of injured mucosa in ulcerative colitis and serum M 30 levels increase in epithelial cell apoptosis. In this study, we aimed to evaluate the relation between M 30 serum levels and ulcerative colitis activity. Methods:Eighty patients with ulcerative colitis and 40 healthy controls were enrolled into the study. The patient group consisted of 31 extensive colitis, 30 left-sided colitis, and 19 proctitis. The activity of ulcerative colitis was determined with clinical and endoscopic findings. Serum M 30 levels, acute phase reactants, and biochemical tests were analyzed in all subjects. Results:Serum M 30 levels in patients with active ulcerative colitis were significantly higher when compared with the healthy controls (165.6 ± 60.6 and 129.6 ± 37.4; P = 0.003). Serum M 30 levels in active left-sided colitis patients was significantly higher when compared with patients in remission phase (180.6 ± 58.5, 141.5 ± 35.4; P = 0.044). When we exclude patients with ulcerative proctitis, M 30 levels in active ulcerative colitis patients were significantly higher than that the patients in remission phase (174.0 ± 63.5, 135.0 ± 29.9; P = 0.017). Conclusions:We found that M 30 levels increase in patients with active ulcerative colitis. Our findings support the role of apoptosis demonstrated by serum M 30 levels in the pathogenesis of active ulcerative colitis.

Ulcerative colitis after anesthesia with desflurane and sevoflurane

To the Editor: The pathogenesis of inflammatory bowel disease (IBD) remains unknown, but is likely multifactorial. Suspected factors include genotype, immune system dysregulation, intestinal barrier dysfunction, and microbial flora. To our knowledge, no associations between IBD and inhalational anesthetics have been reported. Here we describe a patient who underwent anesthesia on separate occasions with desflurane and sevoflurane and on each occasion developed bloody diarrhea of several weeks duration. The patient was subsequently diagnosed as having ulcerative colitis (UC). A 48-year-old man was admitted to our hospital with complaints of bloody diarrhea and weight loss. The patient said that he was having 12–13 episodes of diarrhea per day. His medical history was significant for two surgical procedures. Two years prior to the present visit, at a hospital affiliated with ours, the patient had undergone nasal septoplasty for obstructive sleep apnea. According to the discharge summary, desflurane was used as the surgical anesthetic. The patient said that after the surgery he began to experience bloody diarrhea and went to a general practitioner who, without performing laboratory tests, diagnosed the diarrhea as infectious and prescribed a week-long course of antibiotics. The bloody diarrhea, however, persisted for 1 month The patient’s second operation was a lumbar discectomy that had been performed at our hospital 46 days prior to the present visit. During that operation sevoflurane was used. The patient said that on the day after surgery he began to have diarrhea. During the following 2 weeks the diarrhea increased in frequency and became bloody, and continued up to the time when he applied to our clinic. On physical examination the patient’s temperature was 38.5 C and his heart rate was 92 beats per minute. Other physical findings were normal except for a slight sensitivity to palpation of the abdomen. Laboratory findings were as follows: hemoglobin 9.9 g/dL, hematocrit 37%, leukocyte count 11.1 10/mL, platelets 392,000/lL, glucose 104 mg/dL (normal 70–105 mg/dL), aspartate aminotransferase 8 IU/L (normal 5–40 IU/L), alanine aminotransferase 7 IU/L (normal 5–40 IU/ L), alkaline phosphatase 101 IU/L (normal 80–280 IU/L), gamma glutamyl transferase 31 IU/L (normal 10– 50 IU/L), total protein 5.67 g/dL (normal 6.3–8.4 g/dL), albumin 3.34 g/dL (normal 3.8–5.1 g/dL), erythrocyte sedimentation rate 78 mm/h, and C-reactive protein 107 mg/dL (normal 0–8 mg/dL). Other laboratory findings were normal. Stool specimens were examined for ova, parasites, Clostridium difficile toxin, and cytomegalovirus; none of these were found. Stool cultures showed no pathogenic bacteria. On colonoscopy, the mucosa in the descending colon, sigmoid colon, and rectum was edematous, granular, and fragile without interruption. In the lumen were seen mucus, exudates, and hemorrhagic secretions. The biopsy specimen showed inflammation at the lamina propria with infiltration by lymphocytes, plasmocytes, and eosinophils. The goblet cells were few in number. Crypt abscesses and morphologic distortion of the crypts were visible. The patient was diagnosed as having severe UC and was hospitalized for treatment with mesalazine (oral and enema, 4 g/day each) and prednisolone (oral, 60 mg/day). By the fifth day of treatment the patient’s frequency of defecation decreased to three per day, and blood and mucus were no longer apparent in the stools. One month later, follow-up colonoscopy showed mucosal healing. A literature search revealed that a connection between IBD and inhalational anesthesia might be provided by interleukin-17. Fujino et al found that in patients with IBD interleukin-17 expression was increased in the mucosa and serum compared to normal controls. More recently, Tylman et al reported that in patients undergoing anesthesia with either sevoflurane and fentanyl or propofol and remifentanil, plasma interleukin-17 levels decreased in both groups during surgery, but after surgery the levels increased more rapidly in the sevoflurane group. The findings of these studies are difficult to interpret, given that among the events that lead to UC, it is not yet clear whether interleukin-17 should be considered a cause or an effect.

The efficiency of endoclips in maintaining the gastrointestinal bleeding-related Dieulafoy’s lesion

SummaryBackgroundDieulafoy’s lesion (DL) is a relatively uncommon medical condition characterized by a large tortuous arteriole in the submucosa of any part of gastrointestinal (GI) tract wall that bleeds via erosion likely caused in the submucosal surface by protrusion of the pulsatile arteriole. Compared with other endoscopic hemostatic techniques, clipping alone for DL is limited.AimsThe aim of the present case series study is to identify common clinical and endoscopic features, rates of occurrence, to review the outcome of endoscopic management of upper GI tract DL, and to illustrate the use and the efficiency of endoclips in maintaining the GI bleeding due to DL.Patients and methodsThis case series was conducted at Department of Gastroenterology, Dıskapı Yıldırım Beyazıt Educational and Research Hospital. The patients who were admitted to the emergency department of Dıskapı Yıldırım Beyazıt Educational and Research Hospital underwent gastrointestinal system (GIS) endoscopy between 2008 and 2013 and were assessed retrospectively. Five cases of GI bleeding related to DL were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated.ResultsThe median number of endoscopic hemoclips application in first endoscopy was 4 (2–9). Rebleeding developed in all patients who had hemoclips applied. Re-endoscopy was performed in three of these patients, which controlled the bleeding. Two patients were transferred to surgery.ConclusionsCombination of endoscopic injection and mechanical therapies seems a suitable method for maintaining upper GIS bleeding due to DL. Also, further studies are needed to better define the best endoscopic approach for the treatment of DL.