Hakan Ünal

Acute Pancreatitis Following Doxycycline and Ornidazole Coadministration

CONTEXT Drugs are related to the etiology of acute pancreatitis in approximately 1.4-2.0% of cases. Although antibiotics constitute a small number of the drugs suspected, tetracycline is the most encountered antibiotic among those drugs. CASE REPORT A 33-year-old woman was admitted to the emergency room complaining of nausea and abdominal pain after the use of doxycycline 500 mg and ornidazole 500 mg twice daily for three days for a vaginal infection. She experienced epigastric pain, which worsened over time and radiated to her back. After a detailed evaluation, she was diagnosed as having mild acute pancreatitis which improved with medical treatment. All other possible causes of pancreatitis were eliminated. CONCLUSIONS Antibiotic-associated pancreatitis usually has a silent and mild course. To the best of our knowledge the literature reports only two cases of doxycycline-induced acute pancreatitis reported and there are no reports of pancreatitis associated with ornidazole. Our case is the first case reported in which doxycycline and ornidazole coadministration induced acute pancreatitis.

Acute acalculous cholecystitis associated with acute hepatitis B virus infection

During the course of acute viral hepatitis, some functional and structural changes to the gallbladder can occur. Acute acalculous cholecystitis is an extremely rare complication of acute viral hepatitis. Acalculous cholecystitis associated with acute viral hepatitis can present as different conditions. Some of these are self-limiting and heal spontaneously, while a limited number of cases progress to a gangrenous state, gallbladder perforation, and even to death. We present here a case of acute acalculous cholecystitis associated with an acute hepatitis B virus infection.

Esophageal Mucosal Sensitivity: Possible Links with Clinical Presentations in Patients with Erosive Esophagitis and Laryngopharyngeal Reflux

The goal of this study was to assess whether mucosal sensitivity is related to different combinations of symptoms and lesions in laryngopharyngeal reflux (LPR) and erosive esophagitis and to determine whether reflux pattern is important in the development of the symptoms and lesions of gastroesophageal reflux disease (GERD) or LPR. We conducted a prospective study of 55 unselected new patients: 27 erosive esophagitis patients and 28 LPR patients. The erosive esophagitis group had a significantly higher rate of Bernstein test positivity than the LPR group. The proportions of patients with pathologic acid reflux at the proximal and distal probe were similar in the erosive esophagitis group and in the LPR group. These results were inconsistent with the endoscopic findings. Both retrosternal heartburn and regurgitation symptoms were higher in erosive esophagitis patients. The paucity of classical GERD symptoms and lesions in LPR patients could be attributable to mucosal insensitivity but not to reflux pattern.

Subacutely Formed Bezoar Resulting from Accidentally Ingested Industrial Material

Bezoars are the most common foreign bodies of the gastrointestinal tract. Clinical manifestations vary depending on the location of the bezoar, from no symptoms to acute abdominal syndrome. The ingestion of cling film, which is used for preserving food, may lead to a mechanical obstruction of the gut, especially at the second portion of the duodenal segment, and could manifest with abdominal pain, epigastric distress, nausea, vomiting, and fullness. We report the case of a 72-year-old man who presented with gastric outlet obstruction after accidentally ingesting cling film. He completely recovered after it was endoscopically removed. Cling film is not toxic but has erosive effects. Endoscopic removal of such material is recommended. Moreover, psychiatric intervention and management is imperative to prevent recurrence in such cases.

Aortic flow propagation velocity, epicardial fat thickness, and osteoprotegerin level to predict subclinical atherosclerosis in patients with nonalcoholic fatty liver disease.

Objective: Nonalcoholic fatty liver disease is the most common cause of liver dysfunction in Western countries and an independent risk factor for atherosclerotic heart disease. Appropriate noninvasive parameters are lacking for optimal risk stratification of cardiovascular disease in these patients. We evaluated several recently discovered noninvasive parameters for atherosclerosis in patients with nonalcoholic fatty liver disease: epicardial fat thickness, aortic flow propagation velocity, and osteoprotegerin level. Methods: Forty-one patients (27 men and 14 women; mean age, 37.9±8.9 years) with nonalcoholic fatty liver disease and 37 control subjects (17 men and 20 women; mean age, 34.5±8.6 years) were enrolled in this observational case-control study. Patients with nonalcoholic fatty liver disease diagnosed at a gastroenterology outpatient clinic were included. Patients with cardiac pathology other than hypertension were excluded. Epicardial fat thickness and aortic flow propagation velocity were measured by echocardiography. The serum concentration of osteoprotegerin was measured using a commercial enzyme-linked immunosorbent assay kit. Results: Nonalcoholic fatty liver disease patients exhibited a significantly lower aortic flow propagation velocity (155.17±30.00 vs. 179.00±18.14 cm/s, p=0.000) and significantly higher epicardial fat thickness (0.51±0.25 vs. 0.29±0.09 cm, p=0.000) than control subjects. Osteoprotegerin levels were higher, but not significant, in patients with nonalcoholic fatty liver disease (28.0±13.0 vs. 25.2±10.8 pg/mL, p=0.244). Binary logistic regression analysis showed that aortic flow propagation velocity (OR, –0.973; 95% CI, 0.947–0.999) and waist circumference (OR, –1.191; 95% CI, 1.088–1.303) were independent predictors of nonalcoholic fatty liver disease. Conclusion: In this study, epicardial fat thickness and osteoprotegerin level were higher and aortic flow propagation velocity was lower in patients with nonalcoholic fatty liver disease. Early detection of abnormal epicardial fat thickness and aortic flow propagation velocity may warrant a search for undetected cardiovascular disease in patients with nonalcoholic fatty liver disease. (Anatol J Cardiol 2016; 16: 974-9)

Bilier stent ilişkili duedonal bezoar

Bezoars are concretions of undigested material in the gastrointestinal tract, and are found in less than 1% of patients undergoing upper gastrointestinal endoscopy. Bezoar formation is rare in healthy subjects. Most of the patients who present with bezoar-associated complications have had no gastrointestinal disease. In this report, we present a case with biliary stent-associated bezoar.