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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.

Report of 24 left-sided portal hypertension cases: a single-center prospective cohort study.

Our aim was to analyze patients diagnosed with left-sided portal hypertension prospectively and to document the complications at follow-up. Twenty-four patients with isolated splenic vein thrombosis (diagnosed by ultrasonography or angiography or intraoperatively) and/or isolated fundal varices (diagnosed by endoscopy or endosonography) were involved in this study. Demographics, clinical presentation, diagnostic and therapeutic procedures, and morbidity and mortality were recorded in their follow-up. There were 11 and 13 left-sided portal hypertension cases associated with pancreatic diseases and nonpancreatic disorders, respectively. Chronic abdominal pain and gastrointestinal bleeding were the two most common complaints. All patients except one had isolated esophageal (2 cases) or fundal (21 cases) varices. Thirteen patients had splenomegaly on ultrasonography. On Doppler sonography, the splenic vein could be evaluated in 21 of the 24 patients (9 and 6 had complete and partial occlusion, respectively, and 6 had patent blood flow). Urgent intervention with therapeutic endoscopy and splenectomy was performed for two patients each. Medical therapy was begun for three patients according to the underlying diseases. Three patients underwent elective surgery. Two patients were lost to follow-up after the first visit and the mean follow-up of the remaining 22 patients after diagnosis of left-sided portal hypertension was 20 months. Only one patient (with pancreas cancer) had gastrointestinal bleeding at follow-up. All patients with pancreas and gastric cancer died within 2–12 months. Left-sided portal hypertension has various etiologies. It may be difficult to diagnose this entity both endoscopically and radiologically. Treatment should be directed at the underlying diseases. Recurrent hemorrhage due to left-sided portal hypertension is not usual and the prognosis depends mainly on the underlying etiology.

Detection of an aortoenteric fistula in a patient with intermittent bleeding.

Background A 57-year-old male with an aortobifemoral bypass graft presented to a gastroenterology clinic with a 3-month history of intermittent hematemesis, melena and fever. The patient had received antibiotic therapy 2 months before for the same symptoms; however, following brief regression (∼3 weeks) the symptoms had returned.Investigations Physical examination; analysis of full blood count; measurement of erythrocyte sedimentation rate, C-reactive protein levels, liver enzymes, electrolytes, renal function, serum cholesterol and serum triglyceride; HIV serology; blood, sputum, urine and stool culture analysis; performance of esophagogastroduodenoscopy, colonoscopy, abdominal ultrasonography and multidetector CT scanning.Diagnosis Aortoenteric fistula with an inflammatory mass surrounding the aortobifemoral bypass graft.Management Laparotomy with removal of the aortobifemoral bypass graft, performance of an extra-anatomic right axillofemoral bypass graft and an extra-anatomic right-left femorofemoral bypass graft.

Thrombosis of the portal venous system: a prospective study.

Background Thrombosis in the portal system causes a wide spectrum of clinical pictures. There are few published studies describing the clinical features and consequences of portal venous system thrombosis. We aimed to document presentations and outcomes in patients with thrombosis in the portal and/or splenic veins. Patients and Methods The study included 95 patients who were diagnosed with portal venous system thrombosis in the period September 2001 to April 2006. Demographics, clinical presentation, diagnostic investigation, management, morbidity, and mortality were recorded in their follow-up. Results Of the 95 patients with portal vein thrombosis (PVT), 35 had isolated PVT (IPVT), 27 had isolated splenic vein thrombosis (ISVT), and 33 had thrombosis in both the portal and splenic veins (PSVT). The mean follow-up periods after diagnosis of IPVT, ISVT, and PSVT were 36, 31, and 32 months, respectively. Abdominal pain and gastrointestinal bleeding were the most common symptoms at presentation in the IPVT and PSVT groups, whereas abdominal pain was the dominant symptom in the ISVT group. During the follow-up period, no bleeding was seen in 26 of the 35 (74%) patients with IPVT, in 23 of the 33 (70%) patients with PSVT, and in 24 of the 27 (89%) patients with ISVT. Biliopathy developed during follow-up in 11 of 35 patients with IPVT, in 1 of 27 with ISVT, and in 5 of 33 with PSVT. In the ISVT group, there were 11 deaths, and one each in the IPVT and PSVT groups. Conclusions The etiology of PVT varies in portal and splenic veins. IPVT has a higher morbidity (bleeding and portal biliopathy), whereas ISVT that is not associated with an underlying malignancy has a favorable prognosis.

Recurrent Pancreatitis in a Patient with Autosomal-Dominant Polycystic Kidney Disease

Autosomal-dominant polycystic kidney disease is an inherited disorder characterized by multiple cysts in kidneys and other organs. A 63-year-old man was evaluated for the etiology of recurrent pancreatitis and chronic renal failure. Multiple cysts of kidneys, liver, and pancreas and pancreas divisum was diagnosed. Pancreatitis should be included in the differential diagnosis of abdominal pain in patients with ADPKD. Pancreas divisum may be a predisposing factor for acute pancreatitis in these patients.

CASE REPORT: Severe Recurrent Gastrointestinal Bleeding Due to Angiodysplasia in a Bernard–Soulier Patient: An Onerous Medical Concomitance

Angiodysplasia of the gastrointestinal system (GIS) is a disorder consisting of ectasia of submucosal vessels, which causes acute and chronic bleeding (1, 2). The presence of concomitant bleeding diathesis can increase the frequency and severity of GIS bleeding. Bernard– Soulier syndrome (BSS) is a rare congenital bleeding disorder characterized by a prolonged bleeding time, large platelets, and thrombocytopenia (3). There are three case reports in the literature describing BSS and GIS angiodysplasia patients who benefited from hormonal, endoscopic, and surgical treatment (4, 5). On the contrary, we report a patient with BSS and GIS angiodysplasia who did not respond to those treatment options, illustrating the challenges in the management of such cases.

Intracranial Tuberculomas in a Nonimmuncompromised Patient with Abdominal Tuberculosis Misdiagnosed as Crohn’s Disease

Abdominal tuberculosis (TB) is still a major cause of morbidity and mortality in developing countries and its incidence is also increasing in developed countries (1). It has varied presentations and is usually confused with other conditions in the absence of pulmonary disease. Crohn’s disease poses the greatest problem in the differential diagnosis, because steroid treatment can be lifesaving in inflammatory bowel disease and lethal in intestinal TB (2). Intracranial tuberculoma usually results from hematogenous seeding of tubercle bacilli from primary pulmonary disease. In this report, we present a case of primary abdominal TB, without pulmonary disease, complicated with intracranial tuberculomas in a nonimmuncompromised patient, misdiagnosed and treated as Crohn’s disease.

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.

AN UNUSUAL CAUSE OF ABDOMINAL PAIN IN A 75‐YEAR‐OLD MAN

(Qp/Qs42). The shunt flow ratio is especially important in decision-making for patient management. It has been reported that the presence of a large shunt flow (Qp/ Qs42) with hemodynamic changes and symptoms of heart failure and myocardial ischemia indicate surgery. In conclusion, coronary artery fistulas are rare and usually asymptomatic, as in this case. Nevertheless, they are the most hemodynamically important of coronary artery anomalies and may result in acute myocardial infarction, sudden cardiac death, or unstable angina pectoris due to coronary steal with or without concomitant coronary artery disease.

Gastric Necrosis Due to Rapidly Growing Pancreatic Pseudocyst

TO THE EDITOR: In his excellent recent article, Dr. Talley has pointed out that the rectal examination in gastroenterology may be becoming a lost skill (1). His paper describes the importance of the rectal examination and its technique, particularly in patients being evaluated for chronic constipation and fecal incontinence. I would like to offer an additional caveat from the perspective of a colonoscopist. It is likely that many American endoscopists do only a cursory rectal examination prior to starting colonoscopy. In male individuals, particularly over the age of 50 years, it is reasonable to palpate the prostate gland at the time of the preprocedure rectal examination. We recently showed that the adequacy of palpation of the prostate gland in American adult males in the left lateral position at the time of colonoscopy is often incomplete, and strongly correlated with BMI and weight category (i.e., normal body weight, overweight, obesity, and extreme obesity) (2). We found that the adequacy of prostate palpation could be dramatically improved by having the patient raise one or both knees up toward his chest, a maneuver that takes just seconds to perform. Given the high incidence of overweight and obesity in America, this is an adjunct maneuver that might also improve the quality of rectal examinations performed in such patients being evaluated for chronic constipation and fecal incontinence.