Guldem Kilciler

Decreased oxidation susceptibility of plasma low density lipoproteins in patients with Gilbert's syndrome

Background and Aim:  The association of hyperbilirubinemia in Gilberts syndrome (GS) with a decrease in prevalence of coronary artery disease is a well‐known phenomenon. In this study, the state of low‐density lipoprotein (LDL) oxidation which has been postulated to be a significant determinant at the etiopathogenesis of atherosclerotic disorders was investigated among individuals with GS.

Mean platelet volume and its relationship with carotid atherosclerosis in subjects with non-alcoholic fatty liver disease.

Abstract Background. Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is an emerging risk factor for atherothrombosis. Aims. The aim of this study was to investigate the levels of MPV in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus, and hypertension. In addition, the possible relationship between MPV and carotid artery intima media thickness (CIMT), a well known marker of subclinical atherosclerosis, was also studied. Methods. MPV and CIMT levels were measured in 60 biopsy-proven NAFLD subjects and 54 healthy controls. Age and sex were similar between two groups. Results. Body mass index and waist circumference levels were higher in the NAFLD group when compared to the controls. There were no differences between the two groups regarding LDL cholesterol levels, whereas HDL cholesterol levels were lower in the NAFLD group. MPV and CIMT levels were not different between the two groups. According to the correlation analyses, CIMT levels were positively correlated to age in patients with NAFLD. However, no significant correlation was found between MPV and CIMT levels. Conclusions. The results of this study do not show any difference in MPV levels between subjects with NAFLD and controls. These finding suggests that in the absence of other metabolic risk factors, MPV might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.

Do the Changes in the Serum Levels of IL-2, IL-4, TNFα, and IL-6 Reflect the Inflammatory Activity in the Patients with Post-ERCP Pancreatitis?

Background. Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP) procedure and there are some reports showing cytokine changes in ERCP-induced pancreatits. Goals. To investigate the association between early changes (within 24 hours) in the serum interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)α, and IL-6 levels and the development of post-ERCP pancreatitis. Study. Forty five consecutive patients who underwent therapeutic ERCP and 10 patients with acute pancreatitis without ERCP were enrolled to the study. Serum concentrations of IL-2, IL-4, TNFα, and IL-6 were determined immediately before, 12 hours and 24 hours after ERCP. Results. Seven of the 45 patients (15.5%) developed post-ERCP pancreatitis. The levels of IL-4 at 24 hours after ERCP were significantly lower in the patients with post-ERCP pancreatitis than in those without pancreatitis, while TNFα levels at 12 hours after ERCP were higher in the complicated group than those of the uncomplicated group. The ratios of TNFα/IL-4 at 12 and 24 hours after ERCP were found significantly higher in the patients with post-ERCP pancreatitis than in those without pancreatitis. IL-6 in the complicated patients was found significantly increased at 24 hours after ERCP. Conclusions. The enhancement of serum TNFα and IL-6 levels in the patients with ERCP-induced pancreatitis reflects the inflammatory activity. Additionally, these cytokines together with IL-4 can be used in clinical laboratory monitoring of ERCP.

Low Efficacy of Clarithromycin Including Sequential Regimens for Helicobacter Pylori Infection

Background:  Sequential treatment for Helicobacter pylori (H. pylori) appears to achieve a better eradication rate than triple therapy. However, most of the data have been reported from the Italy, and studies from different population are needed before it is recommended in clinical practice. The present study aimed to assess and compare the efficacy of two separate clarithromycin including sequential regimens in Turkey which is well known with high clarithromycin and metronidazole resistance to H. pylori.

Circulating levels of interleukin-18 in patients with non-alcoholic fatty liver disease

Abstract Background and aims. Non-alcoholic fatty liver disease (NAFLD) is strongly associated with obesity and diabetes mellitus. IL-18 is associated with obesity and metabolic syndrome. Our aim was to investigate the relationship of IL-18 with adiponectin and liver histology in subjects with NAFLD who had no additional disorder such as morbid obesity, diabetes mellitus and hypertension. Methods. Plasma levels of IL-18 and adiponectin were measured by ELISA in 96 male subjects with NAFLD [n = 65 for non-alcoholic steatohepatitis (NASH) and n = 31 for simple steatosis (SS)]. Results. IL-18 levels were not different between the two groups (p = 0.89). There was no significant association of IL-18 with adiponectin, insulin resistance and histopathological findings. Adiponectin was lower in the NASH group compared to the SS group (p = 0.02) and it was found to be negatively correlated with hepatic steatosis and fibrosis (r = −0.442, p < 0.001 and r = −0.292, p = 0.02, respectively). Conclusions. This study indicates that circulating IL-18 levels are not altered in male subjects with NAFLD. These results suggest that in the absence of metabolic risk factors, IL-18 per se may not be involved in the pathogenesis of NASH and SS.

Chronic constipation: facilitator factor for development of varicocele.

AIM To evaluate the possible relationship between varicocele and chronic constipation. METHODS Between April 2009 and May 2010, a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated. Patients were divided into two groups. In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist. All of them were evaluated by color Doppler ultrasonography. All patients with constipation, except for the healthy controls of the second group, underwent a colonoscopy to identify the etiology of the constipation. In the first group, we determined the rate of chronic constipation in patients with varicocele and in the second group, the rate of varicocele in patients with chronic constipation. In both groups, the rate of the disease was compared with age-matched healthy controls. In the second group, the results of colonoscopies in the patients with chronic constipations were also evaluated. RESULTS In the first group, mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years, respectively (P < 0.05). In the second group, mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years, respectively (P < 0.05). In the first group, chronic constipation was observed in 8 of the 69 patients with varicocele (11.6%) and 3 out of 60 in healthy controls (5%), respectively. In this regard, there was no statistical significance between varicocele patients and the healthy control (P = 0.37). In the second group, varicocele was observed in 16 of the 66 patients with chronic constipation (24.24%) and 12 out of 60 in healthy controls (20%) respectively. Similarly, there was no statistical significance between chronic constipation and healthy controls (P = 0.72). Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele, in the second group. In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids. In this regard, there was no statistical significance between chronic constipation and healthy controls (P = 0.80). CONCLUSION Chronic constipation may not be a major predictive factor for the development of varicocele, but it may be a facilitator factor for varicocele.

Large Vesicula Seminalis Cyst: A Very Rare Cause of Constipation and Male Infertility

We report a 35‐year‐old male patient with chronic constipation and infertility for 4 years. Spermiogram revealed severe oligospermia. An external mass compressing the rectum was found during rectal examination and flexible rectosigmoidoscopy. Abdominal computed tomography showed a presacral cystic mass which displaced the bladder anteriorly. The cyst was completely removed with open surgery. Histopathologic analysis revealed a cystic lesion covered with squamous epithelium including polymorphonuclear leukocytes, macrophages and sperm cells. After the operation, the patients symptoms were relieved. We considered that the constipation was caused by external compression by the vesicula seminalis cyst. In cases of constipation with infertility, vesicula seminalis cyst should be kept in mind.

Melatonin and Its Day and Night Rhythm of Alterations in Familial Mediterranean Fever: A Brief Research Letter

Objective: The pineal hormone melatonin plays a crucial role in immunomodulation, mainly by effecting T cells. The aims of the present study were to compare the melatonin levels in patients with Familial Mediterranean Fever (FMF) and healthy controls and to find out if it associates with interferon(IFN)γ and interleukin(IL)-10. Materials and Methodology: Twenty five patients with FMF and 16 healthy donors were enrolled into the study. Melatonin, IFN γ and IL-10 measurements were assayed by using enzyme immunoassay (EIA) method. Results: Serum melatonin levels at 03.30 am in both patients during attack-free phase and healthy controls were significantly higher than those levels of corresponding groups measured at 10.00 am. The melatonin levels at 03.30 and 10.00 am in patients during attack-free phase were higher than those levels measured in healthy controls at the same time points. IFNγ and IL-10 did not show any day and night rhythm in both patients and healthy controls. In addition, there was no association among day and night levels of melatonin, IFNγ and IL-10. Conclusions: We conclude that melatonin may play a role in FMF pathogenesis. However, its modulatory effect on immune response most likely does not depend on T cells. Further comprehensive studies should be performed in order to reveal the role of melatonin in the pathogenesis of this disease.

The Relationship of Plasma Adiponectin with Liver Fibrosis in Morbid Obesity

To the Editor: Nazal et al. reported some interesting data regarding a relation between plasma adiponectin concentrations and liver histology in morbidly obese patients [1]. Although most clinicians believe that an association is already present [2], the study is important because it provides scientific information on this clinically relevant condition. However, we think that some points should be discussed. Firstly, as stated in the text and shown in Table 1, there are significant differences regarding the body mass index, highdensity lipoprotein cholesterol and triglyceride levels, and also the proportions of subjects with hypertension and diabetes mellitus (DM). It is well known that all these parameters affect circulating adiponectin concentrations [3]. Secondly, apart from DM, no information about the glucose tolerance of other subjects can be seen in the text. We know from previous studies that hypoadiponectinemia occurs not only in diabetes but also in people with impaired glucose tolerance (IGT) [4], which is a condition with insulin resistance as well. Obesity is a strong risk factor for the development of DM and also IGT. In light of these clear data, we think that some of the study participants may still have overt glucose dysregulation or DM without implementation of the glucose tolerance test. This issue is important because non-alcoholic fatty liver disease (NAFLD) is associated with prediabetes and circulating adiponectin and insulin concentrations are altered in subjects with disordered glucose metabolism [5]. Lastly, no information about the drug use of the subjects could be seen in the text. We know that adiponectin blood levels and measures of insulin sensitivity may be affected from the medications started for the metabolic problems mentioned above [6, 7]. Finally, we would like to ask the authors whether they can present some additional data by categorizing their patients with metabolic syndrome and NAFLD according to metabolic confounders such as DM, IGT, blood pressure, lipid profile, and medication. This would certainly provide the readers clearer information about the association between adiponectin and liver histology in patients with morbid obesity.

Association of complete blood count parameters with liver histology and atherosclerosis in non-alcoholic fatty liver disease

(3) University of Health Sciences, Gülhane Faculty of Medicine, Department of Radiology, Ankara, Turkey Kadir Öztürk,1 Ömer Kurt,1 Hakan Demirci,1 Tolga Doğan,2 Alptuğ Özen,3 Mehmet Çakır,1 Yusuf Serdar Sakin,1 Gürhan Taşkın,2 Murat Kantarcıoğlu,1 Güldem Kilciler,1 Ahmet Uygun1 Association of complete blood count parameters with liver histology and atherosclerosis in non-alcoholic fatty liver disease