Mehmet Dursun

The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community‐based study

Even though studies on the epidemiology of the irritable bowel syndrome (IBS) are increasing day by day, epidemiological data are still unknown in many regions. Our objective was to determine the IBS prevalence, factors associated with this prevalence and probable risk groups in Southeastern Anatolia.

How to Increase the Diagnostic Value of Malignancy-Related Ascites: Discriminative Ability of the Ascitic Tumour Markers

Making a differential diagnosis between malignant and non-malignant ascites is an important clinical issue, but cytological examination has a relatively low diagnostic sensitivity. This study aimed to find a discriminative model that distinguished between malignancy-related and non-malignant ascites. The study included 107 patients: 50 with non-malignant and 57 with malignant ascites. Ascites was analysed using a range of tumour markers and standard cytology. Standardized canonical discriminant function coefficients were used to distinguish between ascites types. The combination of carbohydrate antigen (CA) 15-3, carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (CYFRA-21.1) discriminated between malignancy-related ascites and non-malignant ascites with an accuracy of 98.8% compared with an accuracy of 77.8% for cytological examination. In conclusion, the use of a discriminant function constructed from a combination of CA15-3, CEA and CYFRA-21.1 could distinguish malignant from non-malignant ascites with greater accuracy than cytological examination. Further studies in larger population groups are warranted.

Correlation of Tumour Markers in Ascitic Fluid and Serum: Are Measurements of Ascitic Tumour Markers a Futile Attempt?

Correlations between tumour markers in ascitic fluid and serum were investigated to determine whether ascitic fluid analysis had any diagnostic advantage over serum in 91 adults with ascites (55 malign; 36 benign). Serum and ascitic fluid were analysed for carcinoembryonic antigen (CEA), cancer antigen (CA) 125, CA19.9, CA72.4, CA15.3, α-fetoprotein (AFP) and cytokeratin-19 fragment (CYFRA). The tumour markers were skewed between the groups so were logarithmically transformed. Correlations between serum and ascitic fluid were tested using Pearsons correlation coefficient. Serum and ascitic fluid levels of CEA, CA125, CYFRA and AFP in the malign group were statistically different and CEA, CA19.9, CA5.3, CYFRA and AFP were statistically different in the benign group. For both groups, all tumour markers were highly correlated in serum and ascitic fluid, with the exception of CYFRA in the malign group. These results indicate that, where malignant ascites is suspected, analysing tumour markers in ascitic fluid does not have any advantage over serum analysis.

Replacement of hystological findings: serum hyaluronic acid for fibrosis, high-sensitive C-reactive protein for necroinflamation in chronic viral hepatitis

Because of limitations in biopsy procedure, several non‐invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non‐invasive procedure in predicting histological findings but lacks on high‐sensitive‐C‐reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis.

The Epidemiological Aspects of Fibromyalgia Syndrome in Adults Living in Turkey: A Population Based Study

Objective: The objectives of this study were to determine the prevalence of the fibromyalgia syndrome [FMS] in Diyarbakır, a city located in the southeastern region of Turkey, and to evaluate associated demographic variables. Methods: This study was conducted in the beginning of 2003. A total of 600 people, randomly selected by stratified cluster sampling, were interviewed in person using a questionnaire consisting of demographic features and history of chronic widespread pain. Individuals with chronic widespread pain were examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS based on the American College of Rheumatology classification criteria. The statistical analysis was performed by using a package program called Epi Info 2000. Results: Fifty-three people were diagnosed with FMS. Based on the study results, the prevalence of FMS was 8.8 percent in our regional study group. The prevalence was higher in women [12.5 percent] than in men [5.1 percent; P = 0.002, OR = 3.038, 95% CI = 1.5–6.1], and subjects in urban areas [11.4 percent] had a higher FMS rate than subjects in rural areas [5.2 percent; P = 0.011, OR = 2.388, 95% CI = 1.2–4.6]. The FMS was most common in the 50- to 59-year-old age group. No difference was observed in terms of education, occupation, and marital status. Conclusion: To the best of our knowledge, this cross-sectional study is the first report on the prevalence of FMS in Diyarbakır. The FMS prevalence was 8.8 percent in our region. The FMS was found 2.45 times more common in women than in men and found 2.3 times higher in urban areas than in rural areas.

Upper Gastrointestınal Bleeding Caused by Small-Cell Lung Cancer: A Case Report

Lung cancer is one of the most common causes of death in the world. Although small-cell lung cancer (SCLC) comprises only 20%–25% of cases, it is an aggressive and fatal cancer that is usually not diagnosed until metastatic disease is already present (1). Distant metastasis from this cancer is usually recognized in the adrenal glands, bone, liver, brain, and kidneys but is uncommon in the digestive system. Duodenal metastasis is an extremely rare condition reported in the literature (2, 3). We report the case of a patient with SCLC who was suffering from hematemesis and melena reflecting upper gastrointestinal bleeding.

Vertical Transmission of Helicobacter pylori : Different Transmission Route

To the Editor:We report a patient with polymyositis who was subsequently found to have esophageal carcinoma, a rare association. A 50-yr-old man presented with progressive dysphagia to solid foods for 6 months. He had been admitted 4 yr ago with progressive proximal muscle weakness of all limbs. There was no history of skin rash, joint pains, oral ulcerations, Raynaud’s phenomenon, and photosensitivity. Neurological examination revealed normal higher mental functions and cranial nerves. There was wasting of shoulder and hip girdle, proximal muscle weakness of grade III/V, with normal power in distal muscle groups. Neck and trunk muscles were weak. Reflexes were normal with flexor plantar responses. There was no sensory impairment. His muscle enzymes were raised, and nerve conduction studies and electromyography had revealed a myopathic pattern. His muscle biopsy was consistent with chronic polymyositis. He was being treated with steroids and azathioprine but with no favorable response. Investigations revealed mild iron deficiency anemia, and normal liver and renal function tests. Collagen profile was normal. Upper GI endoscopy for dysphagia revealed a stricture at 33 cm. Brushings from stricture showed malignant cells. The association of polymyositis with malignant tumor has been known for many years. It was first described in 1916 (1). At times, it may be associated with more than one cancer (2). In the largest series to date (Sigurgeirsson et al.), 9% of 396 patients with polymyositis were found to have cancer, either at that time or within 5 yr of diagnosis of muscle disease (3). A high index of suspicion should be kept in elderly patients (4). It is more frequent in men than in women (3). In most of the cases, the clinical features of malignancy antedate or occur concurrently with polymyositis (5). The progression and regression of the muscle disease is in synchrony with the course of cancer. Although muscle weakness may lessen and serum enzyme levels decline in response to steroid therapy, they will reappear after a few months and may then become resistant to further treatment. A complete resolution of symptoms only occurs after treatment of the associated malignancy. The association of polymyositis and esophageal cancer is rare, and to our knowledge only one case report has been published so far (6).

Kriptojenik ve HBV ilişkili sirozda HFE gen mutasyonları

Background/aims: The liver leads the list among the affected organs in hereditary hemochromatosis. We have limited knowledge about HFE gene mutations in cryptogenic cirrhosis and hepatitis B virus -related cirrhosis, which are the two important sub-titles in liver cirrhosis. We studied HFE gene mutations in these patient groups. Methods: Fiftyeight patients with cirrhosis were included in the study. The patients were divided into two equal groups. Group 1 consisted of patients with cryptogenic cirrhosis and Group 2 of patients with cirrhosis appearing on the base of hepatitis B virus . The following 12 mutations of the HFE gene were studied in both groups: V53M, V59M, H63D, H63H, S65C, Q127H, P160delC, E168Q, E168X, W169X, C282Y, and Q282P. Results: Eighteen patients were female and 40 were male. The average age in the first group was 44.35±20.6 and in the second group was 49.39±12.17; there was no statistically significant difference between the groups (p=0.230). In the cryptogenic cirrhosis patients, the total rate of allelic H63D mutation was found as 24.13% (7/29). C282Y heterozygote mutation was determined in one patient (1/29; 3.44%). In the second group, total allelic mutation rate was 20.68% (6/29). No statistically significant difference was determined between the two groups with respect to mutation rates (p=1.0). The total prevalences of H63D and C282Y mutations were found as 22.4% (13/58) and 1.72% (1/58), respectively. H63D homozygosity was found as 3.44% (2/58) and heterozygosity as 18.96% (11/58). Conclusions: The HFE gene mutation rates in cryptogenic and hepatitis B virus cirrhosis were found to be similar. C282Y mutation has been put forward in this study for the first time in our area.

Karaciğer hastalıklarında (siroz veya hepatit) homosistein ve selenyum düzeyleri

Background/aim: The liver has a crucial role in homocysteine synthesis and metabolism. Important changes in homocysteine metabolism occur when hepatic deficiency exists. Selenium levels have also been reported as being decreased in liver damage. Furthermore, many changes take place in the liver when selenium deficiency occurs, and the role in pathogenesis is being investigated. We aimed to search the changes in homocysteine and selenium levels in liver damage and determine the probable influencing factors. Materials and methods: Twenty-two chronic hepatitis (m:11, f:11, average age: 43.90±15.02), 28 cirrhotic patients (m:25, f:3, average age: 42.50±16.00) and 20 healthy subjects (m:12, f:8, average age: 36.65±8.29) were included in the study. Etiology was hepatitis B in 36, hepatitis C in 7, hepatitis B + D in 3 and Wilson disease in 1 patient. Three patients had cryptogenic cirrhosis. Homocysteine level was measured by fluorescent detector using high performance liquid chromatography (HPLC); selenium level in graphite mode by atomic absorption; AST, ALT, GGT and albumin by Abotte Aeroset autoanalyzer with photometric method; and vitamin B12 and folate levels by ELECYSIS E170 using chemiluminescence method; methylene tetrahydrofolate reductase (MTHFR) gene analysis in DNA of whole blood samples was done. Results: There was no significant difference between the three groups with respect to age. Both chronic hepatitis and cirrhotic groups had higher homocysteine levels than those of the control group (p=0.001). There was no difference in homocysteine levels between chronic hepatitis and cirrhotic groups. On the other hand, there was no difference between chronic hepatitis and control groups with respect to vitamin B12 levels. Vitamin B12 level was higher in the cirrhotic group than in controls and the difference was statistically significant. There was no difference between any of the groups in respect to folate levels. MTHFR gene mutation was similar in both patient and control groups. Selenium level was found to be lower in both patient groups than in the control group (p=0.001). Conclusion: Our results showed that hyperhomocysteinemia in chronic hepatitis and cirrhosis is not related to deficiency in folate and vitamin B12 and MTHFR gene mutation. It is seen that other enzymes involved in homocysteine metabolism might play a part in this process. It is noteworthy that selenium deficiency exists in both chronic hepatitis and liver cirrhosis.

Assidik sıvı hücre sayımında otomatik yöntem yeterince güvenilir bir seçenek midir

Background and aims: Ascitic fluid cell count is used routinely in analysis of ascitic fluid. In this study, two methods used in ascitic fluid cell count were compared (automatic method in which a hemogram device is used and standard manual hemocytometer count method in which a Thoma lam is used). Materials and methods: Twenty-six patients (20 men, six women, age range: 19-63 years) admitted to our clinic with ascites were included in the study and ascites fluid obtained from each patient, following which cell counts were performed by both methods. Results: A total of 44 ascitic fluid samples were examined. The upper limit of normal total White Blood Cell (WBC) count (>500 cell/mm3) was exceeded in 23 samples analyzed by the automatic method and 14 samples by the Thoma lam method. Nine out of 23 patients in whom cut-off levels were exceeded by automatic method had normal results with the Thoma lam method. There was no culture-positive result in any of these nine patients. Conclusions: Overdiagnosis may be obtained by use of the automatic method in evaluating ascitis fluid cell counts and the results of this study indicate that further investigation of this subject should be undertaken.