Yusuf Serdar Sakin

Nonalcoholic fatty liver disease is an independent risk factor for atherosclerosis in young adult men

INTRODUCTION The possible cause of accelerated atherosclerosis in NAFLD may be the relationship with the MetS and its components. Our primary goal was to evaluate the relationship between NAFLD and subclinical atherosclerosis in adult male patients between 20 and 40 years of age. Moreover, we aimed to investigate the changes in this association according to the presence or absence of MetS. METHOD Sixty-one male patients with biopsy-proven NAFLD and 41 healthy male volunteers were enrolled. In order to exclude any interference of confounding factors, we studied a specifically selected group with no additional cardiovascular risk. PWV, CIMT and FMD levels were measured in all patients and controls. RESULTS The levels of cf-PWV were significantly higher in SS and NASH patients compared to the control group (P < 0.001); no significant difference was found between SS and NASH patients (P > 0.05). We found significantly decreased FMD levels in patients with SS and NASH compared with control subjects (P < 0.001). Subjects with NASH had significantly greater CIMT measurements than the SS and controls (P = 0.026, P < 0.001, respectively). Although, NAFLD patients with MetS had increased cf-PWV and CIMT and reduced FMD compared to healthy subjects (P < 0.05), no significant difference existed between NAFLD with Mets and NAFLD without MetS in terms of cf-PWV, CIMT and FMD (P > 0.05) CONCLUSION: The present study showed that the presence of NAFLD leads to increased risk of endothelial dysfunction and atherosclerosis in adult male patients, independent of MetS.

The effect of fatty pancreas on serum glucose parameters in patients with nonalcoholic steatohepatitis

OBJECTIVE Fatty pancreas (FP) is related to obesity, and may have some clinical implications on glucose metabolism. The frequency and importance of FP in patients with nonalcoholic steatohepatitis (NASH) are not clear. This study aimed to investigate: the frequency of FP in patients with NASH, and its effects on serum glucose parameters. METHODS FP was detected and graded by transabdominal ultrasonography (USG) in patients with biopsy-proven NASH and healthy controls. Body Mass Index and waist circumference were recorded, and serum lipids, fasting serum glucose, HbA1c, OGTT 2-h, insulin level, insulin resistance, type 2 diabetes mellitus (DM) and prediabetes rates were detected. RESULTS Eighty-four subjects with NASH and 35 healthy controls were enrolled in the study. There was no FP in 41 (48.8%) of the NASH patients according to the study criteria. Forty-three of the NASH patients and 5 of the controls had different grades of fat in their pancreas (51.2% vs. 14%, p=0.001). The HbA1c and OGTT 2-h results were significantly higher in NASH patients with FP compared to those without FP (p=0.003 and p=0.018). The rates of both prediabetes and DM were also found to be significantly increased in NASH patients with FP (p=0.004). The mean waist circumference was higher in patients with FP (p=0.027). Grade of FP by USG showed no effect on study parameters in subgroup analysis. CONCLUSION FP is common in patients with NASH and increases the rate of prediabetes and DM. The coexistence of both NASH and FP has a further impact on glucose metabolism and DM frequency.

The effect of FAAH, MAGL, and Dual FAAH/MAGL inhibition on inflammatory and colorectal distension-induced visceral pain models in Rodents

Recent studies showed that the pharmacological inhibition of endocannabinoid degrading enzymes such as fatty acid amide hydrolase (FAAH) and monoacyl glycerol lipase (MAGL) elicit promising analgesic effects in a variety of nociceptive models without serious side effects. However, the full spectrum of activities is not observed upon inhibition of either FAAH or MAGL enzymes alone and thus dual FAAH and MAGL inhibitors have been described. Visceral pain is strongly associated with inflammation and distension of the gut. Thus, we explored the comparable effects of FAAH, MAGL, and dual FAAH/MAGL inhibitors on inflammatory and mechanically evoked visceral pain models.

Efficacy of a Modified Sequential Therapy Including Bismuth Subcitrate as First-Line Therapy to Eradicate Helicobacter pylori in a Turkish Population

Eradication rates of Helicobacter pylori with standard triple therapy are not satisfactory. Sequential therapy is an alternative method to overcome this problem.

A Rare Case of Upper Gastrointestinal Bleeding: Duodenal Metastasis of Transitional Cell Carcinoma Originating from Renal Pelvis

To the Editor Transitional cell carcinoma (TCC) is the predominant histologic type of bladder cancer. Much less commonly, TCC can arise in the renal pelvis, which is known as upper tract urothelial cancers. Local invasion through direct extension of the tumor is the most common mechanism of spread. However, vascular or lymphatic metastases may occur [1]. At diagnosis, 75 % of patients have superficial disease, 20 % have locally invasive disease, and only 5 % have distant metastasis, frequently to the lymph nodes, liver, lungs, and bone [2]. Although oral and intestinal metastases of TCC from bladder have been reported previously [2, 5], we present here a rare case of upper gastrointestinal (GI) bleeding secondary to duodenal metastasis of TCC of renal pelvis. A 45-year-old man referred to our clinic from Medical Oncology department for endoscopic evaluation of black stool and decrease in hematocrit level (from 33 to 25 %). In his medical history, radical right nephrectomy was performed to treat patient with invasive high-grade urothelial cell (T3 N1 Mx) cancer at the renal pelvis 2 years ago, and 2 months after, he began treated with radiotherapy and chemotherapy because of metastasis to the cerebellum, peritoneum, and lung. He denied using any medication other than chemotherapeutic agents. On examination, he appeared pale and dark sticky stool was observed at digital rectal examination. At endoscopy, we found a large ulcerated mass at the junction of second and third stage of duodenum (Fig. 1). The bleeding was not observed during the procedure, and any other lesion that explains the bleeding was not observed. For diagnosis, biopsies were performed and the biopsies showed malignant cells in the duodenum. After supportive and acid suppression therapy and erythrocyte replacement, the hematocrit levels remained stable and recurrent hemorrhage was not observed. The patient accepted as inoperable due to disseminated metastasis. After 2 weeks, the patient died due to extensive metastatic disease and sepsis. Urinary bladder TCC is the ninth most common malignancy worldwide [3]. Intestinal metastases of TCC are rarely of clinical significance. Most of them are found in postmortem examinations. In autopsy case series, nearly 13 % of TCC has been found with gastrointestinal metastasis [4]. Upper GI bleeding from duodenal metastasis of TCC was reported in a few studies [2, 5]. But these metastases are originating from the bladder. In our patient, primary origin of TCC is the renal pelvis. To our knowledge, this is the first case with upper GI bleeding originating from the renal pelvis. Although most cases of upper GI bleeding are from peptic ulcer diseases, with these rare cases, duodenal metastasis of TCC must be taken into account as in * Yusuf Serdar Sakin ysakin@gata.edu.tr

Landmark reading alterations in patients with gastro-oesophageal reflux symptoms undergoing diagnostic gastroscopy

BACKGROUND AND STUDY AIMS There is still a debate about the exact measurement of the oesophagogastric junction and the diaphragmatic hiatus among clinicians. The aim of this study was to investigate the differences between landmark readings of gastroscopy on intubation and extubation, and to correlate these readings with a gastro-oesophageal reflux questionnaire. PATIENTS AND METHODS 116 cases who underwent diagnostic gastroscopy between January 2013 and June 2013 were included in this study. Landmark measurements were noted while withdrawing the endoscope and were also evaluated after the gastric air was fully emptied. We first used a frequency scale for the gastro-oesophageal reflux disease symptoms (FSSG) questionnaire in order to investigate dysmotility and acid reflux symptoms in the study population and correlated the FSSG questionnaire with intubation and extubation measurements at endoscopic examination. RESULTS Mean age of included subjects was 49.41±17.7 (19-82) years. Males and females were equally represented. On FSSG scores, the total dysmotility score was 7.99±5.06 and the total score was 15.18±10.11. The difference between intubation and extubation measurements ranged from -3cm to +2cm (mean: -0.4). When an FSSG score of 30 was accepted as a cut-off value, we detected a significant difference between the measurements (p<0.05; t: 0.048). CONCLUSION Accuracy of landmark measurements during gastroscopy is clearly affected from insertion or withdrawal of the endoscope. When differences in measurements between insertion and withdrawal were evident, comparable with the FSSG scores, the results became significantly different. In conclusion, according to FSSG scores, these measurements should be performed at the end of the endoscopy.

Dual FAAH and MAGL inhibition might play a key role in visceral pain

Evaluating and managing any patient with chronic abdominal pain are challenging. Drugs such as nonsteroidal anti-inflammatory drugs, opioids, anti-depressants, and anticonvulsants are clinically used in the treatment of pain (2). Cannabis has been traditionally used to treat gastrointestinal diseases, including abdominal pain, for centuries, and its mechanism has been understood within the past two decades after identification of the endocannabinoid system (ECS) and cannabinoid receptors (CB1 and CB2) (3).

Association of complete blood count parameters with liver histology and atherosclerosis in non-alcoholic fatty liver disease

(3) University of Health Sciences, Gülhane Faculty of Medicine, Department of Radiology, Ankara, Turkey Kadir Öztürk,1 Ömer Kurt,1 Hakan Demirci,1 Tolga Doğan,2 Alptuğ Özen,3 Mehmet Çakır,1 Yusuf Serdar Sakin,1 Gürhan Taşkın,2 Murat Kantarcıoğlu,1 Güldem Kilciler,1 Ahmet Uygun1 Association of complete blood count parameters with liver histology and atherosclerosis in non-alcoholic fatty liver disease

Successful conservative treatment of type 3 injury (ductal injury) developing after ERCP

Although endoscopic retrograde cholangio-pancreatography (ERCP) is considered a safe procedure, it is associated with complications such as pancreatitis, bleeding and perforation of the bile duct, pancreatic duct and duodenum. In recent years, successful conservative treatment in selected patients with complications have increased. We present a case with successful conservative treatment of rare injury (type 3) developing after ERCP.

Efficacy of tocilizumab treatment in cerulein-induced experimental acute pancreatitis model in rats

BACKGROUND/AIMS Acute pancreatitis (AP) is a disease that can cause local and systemic complications that may have high morbidity and mortality. Currently, there is not any specific treatment for AP. In this study, we created an experimental model of AP in rats, and we aimed to demonstrate the histological effectiveness of tocilizumab treatment that antagonizes interleukin-6 (IL-6), one of the key cytokines in the development of AP. MATERIALS AND METHODS Forty-eight rats were divided into six groups for this study. AP model was created by subcutaneous injections of cerulein (20 μg/kg) four times at 1-h intervals. Tocilizumab 4 mg/kg was administered to one of the treatment groups and 8 mg/kg to the other treatment group intraperitoneally. The effects of tocilizumab were revealed by examining pancreatic tissue of the rats histopathologically according to the Schonberg scoring system. RESULTS A comparison between tocilizumab treatment group and AP control group provides statistically significant improvement in AP (p<0.0001). Furthermore, the dose of 8 mg/kg is shown to be more effective than 4 mg/kg (p=0.004). CONCLUSION Our study points out that tocilizumab may be an effective agent for pancreatitis treatment.