Sefa Guliter

Effects of vitamin E treatment on peroxisome proliferator-activated receptor-α expression and insulin resistance in patients with non-alcoholic steatohepatitis: results of a pilot study

Background: Insulin resistance (IR) is commonly associated with non‐alcoholic steatohepatitis (NASH). Peroxisome proliferator‐activated receptor‐α (PPAR‐α) may also play a role in the pathogenesis of NASH. A pivotal role in NASH pathogenesis depends on the hypothesis of increased oxidative stress. The aim of our study was to evaluate the effects of supplemental oral vitamin E, a potent antioxidant, on liver functions, PPAR‐α expression and IR in patients with NASH.

Cholestatic liver disease with ductopenia (vanishing bile duct syndrome) in Hodgkin's disease: Report of a case

Liver involvement is common in advanced stages of Hodgkins disease. However, only a small percentage of patients with Hodgkins disease develops jaundice due to several causes. Vanishing bile duct syndrome secondary to Hodgkins disease is a rare cause of cholestasis in these patients. Only 20, cases, to our knowledge, have been reported so far in adults. We report a case of Hodgkins disease presenting with obstructive jaundice without detectable liver involvement. Liver biopsies revealed intrahepatic cholestasis and ductopenia. Although the patient was given chemotherapy, he died of sepsis and disseminated intravascular coagulation after 24 weeks of admission to hospital.

A Non-Inferiority Study: Modified Dual Therapy Consisting Higher Doses of Rabeprazole Is as Successful as Standard Quadruple Therapy in Eradication of Helicobacter pylori.

The aim is to compare high-dose rabeprazole and amoxicillin containing modified dual therapy (MDT) with bismuth subcitrate containing standard quadruple therapy (SQT) as the first-line Helicobacter pylori eradication treatment in terms of efficacy, safety, and adherence to treatment. A total of 200 consecutive patients diagnosed endoscopically with nonulcer dyspepsia with H. pylori infection were randomly assigned into 2 groups, 1 treated with amoxicillin 750 mg thrice daily plus rabeprazole 20 mg thrice daily (MDT group) or rabeprazole 20 mg b.i.d., bismuth subcitrate 120 mg q.i.d., tetracycline 500 mg q.i.d., metronidazole 500 mg t.i.d. (SQT group). Overall, 196 patients (98 in the MDT group and 98 in the SQT group) completed the study. H. pylori eradication was achieved in 84.7% of patients in the MDT group by intention to treat analysis and 84.9% by per-protocol analysis, which were comparable with SQT group (87.8% and 88.8%, respectively). Adverse events including nausea (P = 0.03), dysgeusia (P < 0.001), diarrhea (P = 0.001), black colored stool (P < 0.001), headache (P = 0.01), and abdominal pain (P = 0.05) were significantly higher in SQT group. The MDT is an efficient and safe treatment choice that could be recommended in the first-line eradication treatment of H. pylori.

Vitamin E Treatment in Patients with Nonalcoholic Steatohepatitis: A Six-Month, Open-Label Study of Sixteen Patients

BACKGROUND Free radicals have a pivotal role in the pathogenesis of nonalcoholic steatohepatitis (NASH). Decreasing oxidative stress might have beneficial effects on the biochemical and histologic progression of this disease. OBJECTIVE We aimed to determine the therapeutic effect of vitamin E, a potent antioxidant, on liver enzymes and histology in NASH. METHODS This 6-month, open-label study was conducted at the Departments of Gastroenterology and Pathology, Gazi University School of Medicine (Ankara, Turkey). Patients aged 18 to 70 years with biopsy-proven NASH were included in the study. All patients received vitamin E 800 U/d in 2 divided doses, orally (capsules) for 6 months. Patients were not advised to change their exercise or dietary habits. Body mass index (BMI) was calculated at months 0 (baseline) and 6. Histologic scoring of steatosis, necroinflammatory grade, and fibrosis stage was performed at 0 and 6 months. Liver enzyme activities (alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], and gamma-glutamyltransferase [GGT]) were monitored monthly. Control biopsy specimens were obtained at the end of the treatment. All of the liver biopsies were read by a single pathologist (G.A.) who was blinded to the clinical, laboratory, and histopathologic data, as well as the sequence of liver biopsies. Assessments of compliance and tolerability of treatment were performed using a pill count and patient interview, respectively, at the end of each month. RESULTS Sixteen patients (12 men, 4 women; mean [SD] age, 45.5 [6.9] years [range, 37-60 years]) were enrolled. All patients completed 6 months of treatment. Mean BMI did not change significantly from baseline. Significant improvements in mean (SD) serum liver enzyme activities were observed at 6 months compared with baseline (ALT: 38.6 [16.3] U/L vs 84.8 [22.1] U/L, respectively, P = 0.001; AST: 29.8 [15.4] U/L vs 46.0 [16.0] U/L, respectively, P = 0.001; ALP: 154.6 [64.1] U/L vs 211.5 [70.4] U/L, respectively, P= 0.011; and GGT: 49.8 [38.5] U/L vs 64.7 [54.4] U/L, respectively, P = 0.002), as well as in total cholesterol level (176.2 [42.0] mg/dL vs 199.6 [60.6] mg/dL; P = 0.02). Posttreatment liver biopsy was available in 13 patients (81%). Significant improvements in the mean (SD) scores of steatosis (1.46 [0.66] vs 2.43 [0.62]; P = 0.002) and necroinflammatory grade (0.84 [0.24] vs 1.31 [0.51]; P= 0.006) were observed at 6 months compared with baseline, respectively. However, no significant change was noted in the mean (SD) score of fibrosis stage (0.77 [0.33] vs 1.12 [0.59], respectively). None of the patients reported any adverse effects. CONCLUSION In this small, 6-month, open-label study, vitamin E treatment was safe and well tolerated and led to potential biochemical and histologic improvements (except in fibrosis) in patients with NASH.

Gastrik preneoplastik bulguların kolon polibi ile ilişkisi

Giris ve Amac: Helicobacter pylori enfeksiyonu ile kolon polibi gelisimi arasindaki iliskiye yonelik calismalarda celiskili sonuclar elde edilmistir. Mide icin preneoplastik oldugu bilinen atrofi ve intestinal metaplazi ile kolon polibi gelisimi arasindaki iliski ise henuz yeterince irdelenmemis- tir. Iki merkezde yurutmus oldugumuz calismada, gastrik preneoplastik bulgu varligi ile kolon polibi arasindaki iliskiyi arastirmayi amacladik. Gerec ve Yontem: Kirikkale Universitesi Tip Fakultesi ve Kirikkale Yuksek Ihtisas Hastanesi Gastroenteroloji polikliniklerine 01.01.2012 ile 01.09.2012 tarihleri arasinda basvuraran hastalardan ozofagogastroduodenoskopi yapilarak Helicobacter pylori icin biyopsi ornegi alinan ve es zamanli kolonoskopi islemi yapilan olgular calismaya dahil edildi. Olgularin demografik ozellikleri, polip saptanan olgularda polip karakteristikleri (buyukluk, sayi, histoloji) ve ozofagogastroduodenoskopik biyopsi sonucuna gore gastrik atrofi-intestinal metaplazi ve Helicobacter pylori pozitifligi Sydney klasifikasyonuna gore kaydedildi. Bulgular: Calismaya yas ortalamasi 57,4±13,3 olan toplam 150 (93 erkek, %62,0) olgu dahil edildi. Olgularin 51’inde (%34,0) en az 1 kolon polibi mevcuttu. Kolon polibi ve adenoma varligi icin atrofi [(Sirasiyla; OR:3,1 (p=0,01) ve OR:3,2 (p=0,02)] bagimsiz risk faktoru idi. Toplam adenomatoz polip capi atrofinin derecesi (p=0,04) ve intestinal metaplazinin derecesi (p=0,01) ile, toplam adenom sayisi ise atrofinin derecesi (p=0,01), intestinal metaplazinin derecesi (p

Diffuse plane xanthomatosis in a patient with Budd-Chiari syndrome and monoclonal gammopathy

Diffuse plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks, and flexural folds. Histology shows foamy histiocytes in the dermis. Approximately half of the cases are associated with lymphoproliferative disorders. Budd-Chiari syndrome is an uncommon condition induced by thrombotic or nonthrombotic obstruction of hepatic venous outflow. We present a case of diffuse plane xanthoma in a 62-year-old man who developed normolipemic plane xanthomas coinciding with Budd-Chiari syndrome and monoclonal gammopathy. We review the English-language literature regarding the rare association of xanthomas and Budd-Chiari syndrome.

Erken evre hemoroid tedavisinde infrared koagulasyon ve lastik bant ligasyon

Giris ve amac: Semptomatik hemoroidlerin tedavisi icin cerrahi disi farkli yontemler olmasina ragmen bunlarin hangisinin daha ustun oldugu tartismalidir. Bu calismada erken evre hemoroidlerin tedavisinde lastik bant ligasyon (LBL) ve infrared koagulasyon (IRK)’un etkinliginin ve komplikasyonlarinin arastirilmasi amaclandi. Gerec ve yontem: Randomize prospektif bu calismada fleksible sigmoidoskopi ve anoskopik inceleme ile 2. derece internal hemoroid tanisi konulan, daha once tedavi edilmemis 51’i kadin, 40’i erkek, median yasi 42 (21–64) yil olan 91 hastaya semptomlar kaybolana kadar 4 hafta ara ile bir veya daha fazla seansta LBL (n=45) veya IRK (n=46) uygulandi. Her seanstan bir hafta sonra ve son seanstan 2, 12 ve 24 ay sonra tedavilerin etkinligi ve komplikasyonlari degerlendirildi. Agri degerlendirmesi 0 ile 10 arasinda skorlanan vizuel analog skala (VAS) ile yapildi. Bulgular: LBL ve IRK gruplarinda ortalama tedavi seans sayisi benzerdi (1.73±0.45 ve 1.78±0.42, p > 0.05). Postoperatif birinci hafta sonunda spontan agri icin ortalama VAS skorlari LBL ve IRK gruplarinda sirasi ile 3.8±2.1 ve 2.4±2.0 idi (p 5 olan hasta sayisi 5 iken, IRK grubunda 0 idi (p 0.05), 12. ayda %88.9 ve %82.6 (p > 0.05), ve 24. ayda %86.7 ve %54.3 (p < 0.01) idi. Sonuc: LBL ikinci derece hemoroidlerin kanama kontrolunde IRK’dan daha etkilidir. Ancak postoperatif erken komplikasyonlar LBL’de daha siktir. Postopreratif 2. yil nuks IRK’da daha sik olmasina ragmen komplikasyonlarin azligi nedeni ile erken evre hemoroidlerin tedavisinde IRK ilk basamak tedavi secenegi olabilir.