Yasar Nazligul

The Metabolic Syndrome Is Associated with Complicated Gallstone Disease

BACKGROUND Gallstone disease (GD) is a common condition worldwide. Several studies demonstrated that the presence of gallstones is strongly associated with cardiovascular disease. The metabolic syndrome is a highly prevalent cardiovascular condition. OBJECTIVE To examine the relationship between complicated GD (CGD) and the metabolic syndrome or its components. METHODS Two hundred seventeen patients with gallstones were examined. All patients underwent biliary ultrasonography after a complete medical history and laboratory examination. Data collection for the diagnosis of metabolic syndrome included measurements of waist circumference, blood pressure and lipids, and biochemical tests. RESULTS Of the 217 patients examined, 115 patients (53%) had CGD and 102 patients (47%) had uncomplicated GD (UCGD). There was a significant difference between the number of patients with large gallstones in the CGD and UCGD groups (n=14 [12%] versus n=2 [2%], respectively; P=0.004). Metabolic syndrome, diabetes mellitus and large waist circumference were more prevalent in the CGD group than in the UCGD group. Homeostatic model assessment of insulin resistance scores were higher in the CGD group than in UCGD group (2.51 [95% CI 0.57 to 23.90] versus 2.20 [95% CI 0.09 to 8.87], respectively; P=0.032). Logistic regression analysis revealed that the presence of metabolic syndrome (OR 1.434; 95% CI 1.222 to 1.846, P=0.014), diabetes mellitus (OR 1.493; 95% CI 1.255 to 1.953; P=0.035) and large gallstones (OR 1.153; 95% CI 1.033 to 1.714; P=0.017) were independent predictors of CGD. CONCLUSION Results of the present study demonstrated that metabolic syndrome, diabetes and gallstone size were associated with CGD. Further prospective studies are needed to understand the clinical importance of this association.

Evaluation of early atherosclerosis markers in patients with nonalcoholic fatty liver disease.

Objectives Nonalcoholic fatty liver disease (NAFLD) is characterized by the excessive accumulation of fat in the liver cells. It is strongly associated with cardiovascular risk factors for atherosclerosis. Flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are noninvasive methods for the evaluation of endothelium. They are considered early markers of atherogenesis. The aim of this study was to evaluate early atherosclerosis markers in patients with NAFLD. Methods We examined 161 patients. All the patients underwent hepatic ultrasonography, transthoracic echocardiography, and brachial artery and carotid artery imaging. Fasting blood samples were drawn from all patients for the determination of lipids, insulin, C-peptide, and fasting blood glucose. HOMA-IR was calculated. Results Among the 161 patients, 44 had normal hepatic ultrasonography, 42 had stage 1 hepatosteatosis, 53 had stage 2 hepatosteatosis and 22 had stage 3 hepatosteatosis. FMD was reduced in patients with NAFLD as compared with the healthy controls (5.9±3.1 vs. 9.6±2.7%, P<0.001). There was a significant negative moderate correlation between ultrasonographic hepatosteatosis grade and FMD (r=−0.556, P<0.001). The mean CIMT was significantly increased in patients with NAFLD as compared with the controls (0.40±0.19 vs. 0.27±0.18, P<0.001). There was a significant positive weak correlation between ultrasonographic hepatosteatosis grade and mean CIMT (r=0.376, P<0.001). Conclusion This study showed that NAFLD is associated with impaired CIMT and FMD, which are early markers of atherosclerosis. These findings may play a crucial role in understanding the pathophysiology of the atherosclerotic process in patients with NAFLD.

Serum paraoxonase and arylesterase activities for the evaluation of patients with chronic hepatitis

The sensitivity of standard biochemical tests for liver function is low and insufficient for a reliable determination of the presence or absence of liver disease. The aim of the present study was to investigate serum paraoxonase and arylesterase activities and lipid hydroperoxide (LOOH) levels, and to find out that whether the measurement of serum paraoxonase and arylesterase activities would be useful as an index of liver function status in chronic hepatitis (CH). Fourty‐four patients with CH (24 CHB and 20 CHC) and 38 controls were enrolled. Serum paraoxonase and arylesterase activities were detected spectrophotometrically. LOOH levels were measured by the FOX‐2 assay. Serum paraoxonase and arylesterase activities were significantly lower in patients with CH than controls (p < 0.001 for both), while LOOH levels were significantly higher (p < 0.001). Paraoxonase and arylesterase activities were inversely correlated with LOOH levels (r = −0.394, p < 0.05; r =−0.362, p < 0.05, respectively). Fibrosis scores of CH patients were significantly correlated with paraoxonase and arylesterase activities and LOOH levels (r =−0.276, p < 0.05; r = −0.583, p < 0.001 and r = 0.562, p < 0.001, respectively). Our results indicated that decrease in the activities paraoxonase and arylesterase may play a role in the pathogenesis of CH. In addition, serum paraoxonase and arylesterase activities measurement may add a significant contribution to the liver function tests.

The effect on serum myeloperoxidase activity and oxidative status of eradication treatment in patients Helicobacter pylori infected.

OBJECTIVES Myeloperoxidase activity has been investigated after eradication of Helicobacter pylori (H. pylori) in infected patients in previous studies but the results are controversial. The aim of this study was to investigate effect on serum myeloperoxidase activity and oxidative status of eradication treatment in H. pylori-infected patients. DESIGN AND METHODS Gastric biopsy specimens were obtained from 30 H. pylori infected patients. Serum myeloperoxidase activity was measured by enzyme-linked immunoassay. Oxidative status was determined using total antioxidant capacity (TAC) and total oxidant status (TOS) measurement and calculation of oxidative stress index (OSI). RESULTS After 2 weeks of the eradication treatment, serum myeloperoxidase activity, TOS and OSI values were significantly lower (all; p<0.001), while TAC was significantly higher (p<0.001). CONCLUSIONS Our results indicate that eradication treatment in H. pylori-infected patients may affect both oxidative stress and myeloperoxidase activity which is an important biomarker in pathogenesis of atherosclerosis.

Role of Chemotherapeutic Agents in the Management of Cystic Echinococcosis

Hydatid disease is caused by infection with the metacestode stage of Echinococcus tapeworms of the family Taeniidae. The primary carriers are dogs and wolves, and humans are accidental hosts that do not contribute to the normal life cycle of this organism. The liver is the most commonly involved organ in the body by cystic echinococcosis (CE) secondary to infection with Echinococcus granulosus . Management options for CE should depend on the World Health Organization (WHO) diagnostic classification. Small (<5 cm) WHO stage CE1 and CE3a cysts may be primarily treated with benzimidazoles; the first-choice drug is albendazole. In some situations the combination of albendazole and praziquantel may be preferred. Chemotherapy with a benzimidazole or albendazole plus praziquantel is also used as adjunctive treatment to surgery and percutaneous treatment. Drug treatments have been the indispensable therapeutic modalities for cystic echinococcosis.

Steatosis Grade is the Most Important Risk Factor for Development of Endothelial Dysfunction in NAFLD

AbstractIt is shown that there are strong associations between nonalcoholic fatty liver disease (NAFLD) and endothelial dysfunction. The aim of our study was to reveal whether steatosis or fibrosis score is more important in the development of endothelial dysfunction in patients with NAFLD in a prospective manner.This cross-sectional study included 266 subjects. These subjects were divided into 2 groups depending on presence of hepatosteatosis sonographically. Patients with hepatosteatosis were also divided into 3 subgroups depending on degree of steatosis: grade 1, 2, and 3. In all patients, Aspartate aminotransferase-to-Platelet Ratio Index and Fibrosis-4 (FIB4) scores were calculated. In addition, flow-mediated dilatation (FMD) measurements were recorded.There was NAFLD in 176 (66.2%) of 266 patients included. There were no significant differences in sex and age distributions between patients with NAFLD (group 1) and controls without NAFLD (group 2) (P = 0.05). Mean Aspartate aminotransferase-to-Platelet Ratio Index score was significantly higher in group 1 compared with the control group (P = 0.001), whereas no significant difference was detected regarding FIB4 scores between groups (P = 0.4). Mean FMD value was found to be significantly lower in group 1 (P = 0.008). Patients with grade 3 hepatosteatosis had significantly lower FMD values than those with grade 1 steatosis and controls (P = 0.001). In univariate and multivariate analyses in group 1, no significant difference was detected regarding mean FMD measurements (P = 0.03). Again, no significant difference was detected in mean FMD measurement between FIB4 subgroups among patients with NAFLD and the whole study group (P = 0.09).The endothelial dysfunction is associated with steatosis in patients with NAFLD.

Decreased parasympathetic activity in patients with functional dyspepsia.

Objective Functional dyspepsia (FD) can be described as the presence of symptoms such as bothersome postprandial fullness, early satiation, epigastric pain, and burning without any evidence of structural disease. The aim of this study was to evaluate the autonomic nervous system using heart rate variability (HRV) in patients with postprandial distress syndrome and epigastric pain syndrome. Patients and methods The study population included 64 consecutive patients with a diagnosis of FD and 62 age-matched and sex-matched healthy control individuals with no clinical evidence of gastrointestinal, systemic, or cardiovascular diseases. All patients underwent upper gastrointestinal endoscopy and 24 h Holter monitoring. Results There were 30 patients with postprandial distress syndrome and 34 with epigastric pain syndrome. Twenty-four hour square root of the mean squared differences of the successive normal to normal intervals (RMSSD) (30.5±12.4, 35.8±13.9; P=0.047), 24 h proportion derived by dividing the number of interval differences of successive normal to normal intervals greater than 50 ms (PNN50) (9.8±3.9, 14.1±7.3; P=0.017), daytime PNN50 (6.8±1.6, 18.4±13.8; P<0.001), night SD of the normal to normal intervals (SDNN) (111.4±39.9, 133.4±29.8; P=0.001), and night RMSSD (31.7±12.4, 38.2±17.5; P=0.019) were significantly lower in patients with FD than controls. Other HRV parameters were not significantly different between the two groups. Changes in these parameters showed a decreased parasympathetic tone and discordance in sympathovagal activity in FD. Conclusion Our study showed decreased parasympathetic activity in the patients with FD. Further studies are required to evaluate the significance of HRV parameters and to clarify the mechanism of decreased parasympathetic activity in patients with FD.

Should screening for colorectal neoplasm be recommended in patients at high risk for coronary heart disease: a cross-sectional study.

AbstractColorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN.This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD (<10%), and a high FRS (>20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD.The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P < 0.05 for all). An increased CIMT, a decreased FMD, and a high FRS score were significantly associated with the high risk for the presence of CRC (odds ratio [OR]: 6.018, OR: 3.699, and OR: 4.120, respectively). An increased CIMT, a decreased FMD, and an intermediate FRS were significantly associated with the risk for the presence of overall-CRN (OR: 3.607, OR: 1.866 and OR: 2.889, respectively).The risk for CRN increases as the risk for developing CHD increases. It can be suggested that screening for CRN can be recommended for individuals who are at high risk for developing CHD.

Elevation of B-type natriuretic peptide level in asymptomatic hepatitis B virus-positive patients is not associated with abnormalities of cardiac function.

Objectives: To compare B-type natriuretic peptide (BNP) and echocardiographic parameters in patients with hepatitis B virus (HBV) and healthy control subjects. Subjects and Methods: 52 consecutive patients with HBV and 47 healthy controls were examined. All subjects underwent transthoracic echocardiography after a complete medical history and laboratory examination including BNP, C-reactive protein (CRP) and high-sensitivity CRP (hsCRP). Results: Demographic characteristics were similar in patients with HBV and the control group. No significant difference was found in conventional Doppler and tissue Doppler parameters between the two groups. BNP levels were significantly higher in patients with HBV [6.5 ng/l (range 0.5-85.2)] than controls [4.3 ng/l (range 0.5-18.3)], p = 0.039. hsCRP [3.25 mg/l (0.02-40.2) vs. 0.5 mg/l (0.02-8.0)] levels were significantly higher in patients with HBV than control subjects (p < 0.001). Conclusion: Patients with HBV had higher BNP, CRP, and hsCRP levels than controls. Echocardiographic findings were similar in both groups. This slight BNP elevation in HBV patients may be related to chronic inflammation due to HBV.

Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi

Objectives: To compare endothelial changes after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in clear corneal graft. Methods: In this study, fifty six eyes undergone DALK (DALK Group) and eighty two eyes undergone PK (PK Group) due to various reasons are included. After operation at 1st, 12th, 24th and 36th month central corneal endothelial cell density (CD) and variability coefficient(CV) value examined by specular microscopy of clear graft which have not had additional surgery, greft rejection or glaucoma during follow up period were compared. Results: Endothelial cell density in DALK group were 2426p587 cell/mms 2289p579 cell/mms, 2222p541 cell/mms, 2175p521 cell/mms, in PK group were 2595p589 cell/mms, 2064p583 cell/mms, 1759p510 cell/mms 1509p494 cell/mms at 1st, 12th, 24th and 36th month respectively. Decrease in CD values were 5.9% at 12th month, 7.5% at 24th month and 9.4% at 36th month comparing with first month in DALK group. Decrease in CD values were 18.4% at 12th month, 30.2% at 24th month and 40.3% at 36th month comparing with first month in PK group. Variability coefficient (CV) values in group DALK were 23.3p6.2, 24.2p6.4, 24.2p6.1 and 24.5p5.6 at 1st,12th, 24th and 36th month respectively. Variability coefficient (CV) values in group PK were 19.6p3.4, 23.2p5.4, 25.9p6.2 and 27.5p5.7 at 1st,12th, 24th, and 36th months respectively. Conclusion: More polymegatism and more decrease in endothelial cell density with time were assessed in grafts undergone PK compared with grafts undergone DALK.Objectives: The aim of this study was to determine the effect of fracture type and angular deterioration on the outcome of calcaneal fractures. Materials and methods: Thirty-two patients (23 males, 9 females; mean age 45 years) with calcaneus fractures retrospectively reviewed. Twenty-four fractures were closed, and eight fractures were open. Bohler and Gissane angles were measured using patient’s before, and after reduction X-ray films. According to the EssexLopresti classification there were three type I, 14 type II, and 15 type III fractures. Five patients were treated with casting (Group I), 19 patients with closed reduction K-wire application (Group II), and 8 patients with plate fixation. Final clinical outcome were assessed by Maryland Foot Score. Mean follow-up period was 109 weeks.Amac: Bu calismada kalsipotriol-betametazon dipropionat ile tedavi edilen plak psoriazisli olgularda doku duzeyinde hucresel immunitenin ve serumda sitokin duzeylerinin rolunun arastirilmasi amaclandi. Gerec ve yontem: Calismaya plak tip psoriazisli 20 olgu alindi. Hastalarin tedavi oncesi ve sonrasi psoriatik lezyonlari ile saglam deriden biyopsi ve periferik kan ornekleri alindi. Bulgular: Immunohistokimyasal incelemede, CD4+, CD8+ ve CD25+ T lenfositler, tedavi oncesi lezyonlu dokuda saglam doku ve tedavi sonrasi doku ile kiyaslandiginda anlamli bir sekilde yuksekti (sirasiyla, p0.05). Sonuc: Calismamizda lezyonlu deride CD4+ ve CD8+ hucre birikimi oldugunu ve CD4+ T lenfositlerin daha hâkim hucre grubu oldugu gosterildi. Uygulanan topikal tedavinin etkinligine paralel olarak lezyonlarda duzelme olmasi ve lezyonlu bolgelerde CD4+ ve CD8+ T hucrelerinde anlamli bir azalma meydana gelmesi, Th lenfositlerin hastaligin immunopatogenezinde onemli rolunun oldugu tezini desteklemektedir. Ancak, sonuclarimiz, hastaligin kronik ozelligi ile uyumlu olarak T hucrelerin dokuda yine de yeterince kaldigini ve topikal tedavinin hastaligin aktivasyonunu engelleyemedigini gostermektedir.