Yuksel Seckin

Gastric Tissue Oxidative Changes in Portal Hypertension and Cirrhosis

Gastric mucosal lesions are very common in portal hypertension and cirrhosis. The aim of this study was to assess for oxidative gastric tissue damage in cirrhosis and evaluate relations with portal hypertension and cirrhosis parameters. The study included 30 patients with cirrhosis and 30 controls. Each patients history, physical examination, and laboratory findings were recorded, and multiple biopsies of the gastric antrum were obtained at endoscopy. A set of antral biopsies was also collected from each control subject. Each tissue specimen was analyzed for levels of glutathione peroxidase (GPX), superoxide dismutase (SOD), and catalase (CAT) activity and level of malondialdehyde (MDA). Patients’ gastric GPX, SOD, and CAT levels were significantly lower, and MDA levels were higher, than in the control group. The GPX activity level in the specimens was moderately negatively correlated with portal vein diameter (P < 0.05, r=−0.45) and spleen length (P < 0.05, r=−0.45). In this study gastric tissue oxidative markers showed that antral oxidative factors worsen in cirrhosis. Oxidative stress may not be a clinical condition but it obviously shows gastric tissue damage and may explain many patients’ gastric lesions and hemorrhage.

Common bile duct diameters after endoscopic sphincterotomy in patients with common bile duct stones: ultrasonographic evaluation

AbstractBackground: One of the most reliable, frequently used imaging techniques in cholestasis is ultrasonography (US) for the diagnosis of common bile duct (CBD) stones. Methods: In this study, changes in diameters of CBD were determined ultrasonographically before and after endoscopic sphincterotomy (ES) in 46 patients with stone-induced dilated CBD. Results: There was a significant decrease in CBD diameter measured 1 week after ES and extraction of stone (p < 0.001). In 87% of cases, the difference was more significantly pronounced during the first 24 h of ES. The mean CBD diameters on US were 13.70 ± 3.00 mm (10–21 mm) before and 9.13 ± 2.90 mm (4.2–18 mm) 24 h after endoscopic treatment (p < 0.001). After ES, six patients (13%) with inadequate decreases in CBD diameters were found to have residual stones. Conclusion: US can show residual stones in the CBD with the same efficacy as endoscopic retrograde cholangiopancreatography.

Prevalence of celiac disease in parents of preterm or low birthweight newborns.

Aim:  Celiac disease (CD) may present with atypical symptoms, including poor pregnancy outcomes, such as preterm and low birthweight (LBW) deliveries, thus we aimed to investigate the frequency of CD in mothers and fathers of preterm or LBW newborns.

The influence of vitamin D deficiency on eradication rates of Helicobacter pylori

BACKGROUND Helicobacter pylori eradication therapy improves the healing of various gastro-duodenal diseases such as chronic gastritis and peptic ulcer, and also reduces gastric cancer incidence. Several studies have reported on risk factors other than antibiotic resistance related to Helicobacter pylori eradication failure. OBJECTIVES In this study, we aimed to investigate whether or not the serum levels of 25-hydroxy-vitamin D (25(OH)D) influence eradication rates of H.pylori. MATERIAL AND METHODS 220 patients diagnosed with H.pylori gastritis using endoscopic biopsy had their 25-OH vitamin D levels measured via the electrochemiluminescence method before beginning eradication therapy of H.pylori. Gastric biopsies obtained at endoscopy were examined for H.pylori strains and histopathologic findings. All patients were treated with bismuth-containing quadruple therapy for 14 days. H.pylori eradication was determined via the 14C-urea breath test performed 4 weeks after the end of therapy. Based on the 25-OH vitamin D levels, the patients were divided into 2 groups: group 1 (deficient) had a vitamin D level of <10 ng/mL, while group 2 (sufficient) had a vitamin D level of ≥10 ng/ mL. RESULTS Eradication was successful in 170 (77.2%) patients and failed in 50 (22.7%) patients. The prevalence of 25(OH)D deficiency was 30.5%. Mean 25(OH)D levels were significantly lower in the eradication failure group compared to the successful treatment group (9.13 ±4.7 vs 19.03 ±8.13; p = 0.001). There were significantly more patients with deficient 25(OH)D levels in the failed treatment group compared to the successful treatment group (p = 0.001). CONCLUSIONS Our findings suggest that 25-OH vitamin D deficiency may be considered a risk factor related to eradication failure of H.pylori, which may lead to a need for supplementation of vitamin D before eradication of H.pylori.

Association of eNOS Gene Polymorphisms G894T and T-786C with Risk of Hepatorenal Syndrome

Background. There are no studies investigating the relationship between endothelial nitric oxide synthase (eNOS) gene polymorphisms and hepatorenal syndrome (HRS). Aim. The purpose of this study is to elucidate whether eNOS gene polymorphisms (G894T and T-786C) play a role in the development of type-2 HRS. Methods. This study was carried out in a group of 92 patients with cirrhosis (44 patients with type-2 HRS and 48 without HRS) and 50 healthy controls. Polymorphisms were determined by polymerase chain reaction (PCR) and melting curve analysis. Results. We did not find any significant difference in allele and genotype distributions of the eNOS -T-786C polymorphism among the groups (p = 0.440). However, the frequency of GT (40.9%) and TT (13.6%) genotypes and mutant allele T (34.1%) for the eNOS G894T polymorphism were significantly higher (p < 0.001 and p < 0.001, resp.) in the HRS group than in both the stable cirrhosis (14.6%, 4.2%, and 11.5%, resp.) and the control (22.0%, 2.0%, and 13.0%, resp.) groups. Conclusion. The occurrence of mutant genotypes (GT/TT) and mutant allele T in eNOS -G894T polymorphisms should be considered as a potential risk factor in cirrhotic patients with HRS.

Eosinophilic ascites, as a rare manifestation of eosinophilic gastroenteritis: a case report

Eosinophilic ascites (EA) can present as an unusual finding of eosinophilic gastroenteritis. We presented this case to remind eosinophilic acid in cases with unexplained etiology. A 29-years old man presented to an emergency department with abdominal swelling, progressively worsening nausea, and fatigue over one month. The patient had no history of allergic disease. There was moderate ascites in the physical examination. Percent eosinophil was 60% in peripheral blood smear while IgE level was increased in the serum. There was ascites on abdominal computed tomography (CT) scan. Serum ascites-albumin gradient (SAAG) was non-portal. Eosinophilic infiltration was detected biopsy samples obtained by upper GI tract endoscopy and in bone marrow aspiration and biopsy. The abdominal pain, ascites and all laboratory tests were completely recovered after 12 weeks of prednisolone therapy. Eosinophilic gastroenteritis should be considered in case of markedly increased eosinophilia in ascites fluid.

Methylprednisolone prevents bacterial translocation in thioacetamide-induced liver failure in rats

BACKGROUND/AIMS Steroids have been shown to prevent intestinal oxidative stress. We investigated the effects of methylprednisolone on intestinal oxidative damage and bacterial translocation in thioacetamide-induced liver failure in rats. MATERIALS AND METHODS Group 1 (n=8) was the control group. In group 2 (n=8), the thioacetamide group, rats received 300 mg/kg intraperitoneal thioacetamide daily for 2 days. In group 3 (n=8), the thioacetamide+methylprednisolone group, treatment with methylprednisolone (30 mg/kg intraperitoneal) was commenced 48 h before the first dose of thioacetamide. In group 4 (n=8), the methylprednisolone group, the rats received only methylprednisolone (30 mg/kg intraperitoneal). RESULTS Serious hepatic and intestinal oxidative damage and high bacterial translocation frequencies were observed in the thioacetamide group compared with those of the controls. Bacterial translocation frequency in the thioacetamide+methylprednisolone group was significantly lower than that in the thioacetamide group (p<0.05). Intestinal thiobarbituric acid-reactive substances and myeloperoxidase levels and tissue damage scores for the intestines in the thioacetamide+methylprednisolone group were lower than those in the thioacetamide group (p<0.01, p<0.01, and p<0.0001, respectively). CONCLUSION Our findings suggest that methylprednisolone reduces bacterial translocation by preventing intestinal oxidative damage in this model of acute liver failure in rats.

An evaluation of the indications, complications and results of patients with percutaneous endoscopic gastrostomy

Aim of this study is to evaluate the indications, complications and results of patients undergoing percutaneus endoscopic gastrostomy. In our study, we evaluated the outpatients or hospitalized patients applying to Turgut A–zal Medical Center between April 2008-November 2010. 247 patients who would be unable to perform oral feeding for at least 4 weeks and underwent for PEG procedure were evaluated retrospectively. PEG procedure was performed 296 times on 247 cases. The most common indication for PEG has been neurological diseases (39.2%), other indications follow up in order with respiratory failure (10.5%), multiple trauma (10.1%), hypoxic encephalopahty (8.6%) and the other diseases (6.5%). Complications associated with PEG were wound infection (5.6%), tube blockage (3.2%), tube fracture (2.4%), tube leakage (2.4%), breakage (2.4%), and buried bumper syndrom (3.2%). Overall minor complication rate was %13,7, and overall major complication rate (buried bumpersyndrome) was 3.2%. The most common complication was wound infection. During follow-up, 102 patients died of primary disease. 30 days (early) and 1 year mortality rates were 14.3% and 39.5%. Overall mortality rate was 41,3% and mean survival was 17.34 ± 0.7 months. PEG tube was removed in 10 cases because of a adequate oral intake. The mean duration of a PEG tube stay was 16 ± 1.2 months. PEG is a procedure requiring no general anesthesia with low morbidity and mortality rates. It is also an effective, safe method which can be performed at the bedside. It should be one of methods prefered for patients who need long-term enteral nutrition.

Portal hypertension and cholestasis due to Echinococcus alveolaris: a case report -

Alveolar ecchinococcosis (AE) is a rare but potentially life-threatening serious parasitic disease. The parasit may involve liver and, most importantly, expand vessels and biliary tract. We present here a case of esophageal variceal bleeding due to portal hypertension and cholestasis secondary to AE. We present the case of a 30-year-old female patient who was admitted to emergency service with hematemesis, melena and icter. Upper gastrointestinal endoscopy revealed gastroesophageal varices and portal gastropathy. Contrasted computerized tomography examination showed a solid calcific lesion (cross dimension 6x11 and 5x9 cm.) of biliary tracts causing dilatation. An USG guided biopsy from the mass was performed and histological examination revealed AE. We also review here the literature on portal hypertension and cholestasis due to Echinococcus alveolaris. AE is rare a disease and may cause severe complications. Endoscopic and percutaneous drainage for biliary obstruction caused by hepatic AE has a palliative effect even in the late stages. Liver transplantation was recommended but this operation was not performed for living donor shortage. Liver transplantation should be considered in the management of advanced liver alveolar echinococcosis.

Ascites and hepatic involvement: a rare and atypical presentation of Burkitt Lymphoma /Burkitt lenfomanin asit ve karaciger tutulumunun oldugu, nadir gorulen atipik prezentasyonu

Burkitt lymphoma (BL) is an uncommon form of lymphoma in adults. In this disease, extensive involvement of the omentum and the peritoneum is rare. We present this case with ascites because it is such a rare and overlooked clinical presentation of BL. A previously healthy 20-year-old man was admitted to our hospital with abdominal pain, distension, and night sweats. Physical examination revealed massive ascites. Computerized tomography showed liver metastasis and ascites, but no pathologic thoracal or abdominal lympadenopathy was reported. Atypical lymphocytic cells with cytoplasmic vacuoles were determined on cytologic examination of ascites. We detected starry sky view on the bone marrow examination. On immunophenotyping, cells were CD20 positive, but negative for CD30, CD79a/Tdt. Patient was diagnosed as BL. Burkitt lymphoma should be considered in young patients presenting with ascites and hepatic mass even without lymphadenopathy or focal gastrointestinal masses.