RESUMEN
The patient had a two month history of gastrointestinal symptoms. Upper gastrointestinal endoscopy disclosed 5 mm nodular lesions were seen in the prepyloric area. On pathological examination, two granulomatous lesions were detected in biopsy specimen. Ehrlich Ziehl-Neelsen staining and cultures of the biopsy material were negative, but polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex DNA was positive. Clinical diagnosis of primary gastric tuberculosis (PGTb) was supported by positive PCR assay and histopathological findings. After antituberculosis treatment, nodular lesions were not detected. The diagnosis of PGTb was confirmed definitively by the success of treatment and repeated endoscopic examination.
Asunto(s)
Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa , Tuberculosis Gastrointestinal/diagnóstico , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Biopsia , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Endoscopía Gastrointestinal , Femenino , Humanos , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Estómago/microbiología , Estómago/patología , Tuberculosis Gastrointestinal/tratamiento farmacológico , Tuberculosis Gastrointestinal/microbiología , Tuberculosis Gastrointestinal/patologíaRESUMEN
BACKGROUND AND AIM: Urea breath test (UBT) results could be false negative in patients taking antisecretory drugs. This effect would be prevented by citric acid administration during UBT. We prospectively investigated whether acidified 14C-urea capsule prevents false negative UBT results in patients taking antisecretory drugs and show interference with the duration of medications. METHODS: Sixty Helicobacter pylori positive patients were included. Pantoprazole (40 mg/day) was given to 27 patients for 28 days and ranitidine (300 mg. o.d.) to 33 patients for 60 days. Urea breath tests were repeated on days 14 and 28 in both groups and on day 60 in the ranitidine group. RESULTS: The baseline mean breath counts of two groups did not show any significant difference. Pantoprazole led to a significant decrease in mean breath counts on day 14 (P < 0.005). Six of 27 and 3 of 25 patients taking pantoprazole developed negative or equivocal UBT results on days 14 and 28, respectively. Two of 32, 2 of 32 and 3 of 21 patients taking ranitidine developed negative or equivocal UBT results on days 14, 28 and 60, respectively. CONCLUSIONS: The use of acidified 14C-urea capsule did not prevent false negative UBT results in patients taking pantoprazole and ranitidine, and the duration of medication does not affect the test results.
Asunto(s)
2-Piridinilmetilsulfinilbencimidazoles/uso terapéutico , Pruebas Respiratorias , Ácido Cítrico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/metabolismo , Inhibidores de la Bomba de Protones/uso terapéutico , Ranitidina/uso terapéutico , Urea , 2-Piridinilmetilsulfinilbencimidazoles/efectos adversos , Cápsulas , Radioisótopos de Carbono , Reacciones Falso Negativas , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/microbiología , Humanos , Pantoprazol , Valor Predictivo de las Pruebas , Estudios Prospectivos , Inhibidores de la Bomba de Protones/efectos adversos , Ranitidina/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND AIM: The association of hyperbilirubinemia in Gilbert's syndrome (GS) with a decrease in prevalence of coronary artery disease is a well-known phenomenon. In this study, the state of low-density lipoprotein (LDL) oxidation which has been postulated to be a significant determinant at the etiopathogenesis of atherosclerotic disorders was investigated among individuals with GS. METHODS: For this purpose, serum cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, triglycerides, uric acid, apolipoprotein A and B, bilirubins, thiobarbituric acid-reactive substances, and the sensitivity of LDL oxidation levels, as well as serum alanine aminotransferase, aspartate aminotranserfase, gamma glutamyl transferase, and alkaline phosphatase activities, were determined in 17 patients with Gilbert's syndrome and 15 healthy adults. RESULTS: There was no significant difference between the groups except the indirect bilirubin parameter (P < 0.001). In comparison with the healthy individuals, LDL oxidation levels between 75 and 120 min were significantly lower (P < 0.005) along with prolonged lag-phase in GS patients, indicating a delay in oxidation susceptibility. CONCLUSION: It is suggested that the chronic hyperbilirubinemia leading to a lag-phase prolongation in LDL oxidation and a decrease in LDL oxidation may be reason for the low percentage of coronary artery disease.
Asunto(s)
Enfermedad de Gilbert/sangre , Lipoproteínas LDL/sangre , Adulto , Bilirrubina/sangre , Biomarcadores/sangre , Estudios de Casos y Controles , Humanos , Peroxidación de Lípido , Oxidación-Reducción , Síndrome , Factores de Tiempo , Adulto JovenRESUMEN
Percutaneous endoscopic gastrostomy is a safe and easy method and carries a low mortality and complication rate. The buried bumper syndrome is a rare and late complication of percutaneous endoscopic gastrostomy tube placement. An 80-year-old man with bilateral basal ganglia bleeding was unable to swallow safely and required tube feeding. A Flexiflo Inverta percutaneous endoscopic gastrostomy tube was successfully inserted by pull technique. One year later, he was readmitted to our clinic because of nonfunctioning tube and peristomal cellulites. Endoscopy demonstrated dimpling of the gastric mucosa on the anterior wall of the stomach. Abdominal computed tomography revealed the bumper to be buried in the abdominal wall. The tube was removed by external traction, without any abdominal incision, and a different site was used for the insertion of a new percutaneous endoscopic gastrostomy tube. No further problems were encountered over the follow-up period of nine months. As a result, the Flexiflo Inverta percutaneous endoscopic gastrostomy tubes with externally removable internal bumpers were found useful in the treatment of buried bumper syndrome, and the buried bumper was easily removed by external traction without any endoscopic or surgical methods.
Asunto(s)
Nutrición Enteral/efectos adversos , Nutrición Enteral/instrumentación , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Gastrostomía/efectos adversos , Gastrostomía/instrumentación , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Cefazolina/uso terapéutico , Remoción de Dispositivos/métodos , Endoscopía , Diseño de Equipo , Falla de Equipo , Migración de Cuerpo Extraño/diagnóstico , Gastrostomía/métodos , Humanos , Intubación Gastrointestinal/efectos adversos , Intubación Gastrointestinal/instrumentación , Masculino , Estomas Quirúrgicos/microbiología , Estomas Quirúrgicos/patología , Síndrome , Tomografía Computarizada por Rayos X , Tracción , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/etiologíaRESUMEN
A 55-year-old hemiplegic woman with percutaneous endoscopic gastrostomy (PEG) was referred to our clinic for upper gastrointestinal system bleeding and for a high level of cholestatic enzymes. She had a medical history of cerebra vascular accident three years previously and cholecystectomy one year previously. We performed gastroscopy and saw a retained surgical sponge in the bulbus. After removal of the gossypiboma, endoscopic sclerotherapy was performed for the bleeding area at the bulbus. After the procedure, the upper gastrointestinal bleeding stopped and the high level of cholestatic enzymes returned to normal.
Asunto(s)
Cavidad Abdominal/patología , Migración de Cuerpo Extraño/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Tapones Quirúrgicos de Gaza/efectos adversos , Cavidad Abdominal/cirugía , Femenino , Migración de Cuerpo Extraño/complicaciones , Hemorragia Gastrointestinal/etiología , Humanos , Persona de Mediana EdadRESUMEN
Ghrelin possesses various biological activities -- it stimulates growth hormone (GH) release, plays a major role in energy metabolism, and is one of the hormones that affects body composition. It also plays a role in modulating immune response and inflammatory processes. In this study we aimed to determine whether serum ghrelin levels had correlation with markers associated with disease activation. We also investigated any probable relationship between serum ghrelin level and nutritional status. Serum levels of ghrelin and its relationship with disease activity and nutritional status were evaluated in 34 patients with ulcerative colitis (UC), 25 patients with Crohn's disease (CD), and 30 healthy controls. Serum ghrelin levels, serum IGF-1 and GH levels, and markers of disease activity (sedimentation, C-reactive protein, and fibrinogen) were measured in all subjects. Body composition and nutritional status was assessed by both direct (by anthropometry) and indirect (by bioimpedance) methods. Serum ghrelin levels were significantly higher in patients with active UC and CD than in those in remission (108 +/- 11 pg/ml vs. 71 +/- 13 pg/ml for UC patients, P < 0.001; 110 +/- 10 pg/ml vs. 75 +/- 15 pg/ml for CD patients, P < 0.001). Circulating ghrelin levels in UC and CD patients were positively correlated with sedimentation, fibrinogen and CRP and was negatively correlated with IGF-1, BMI, TSFT, MAC, fat mass (%), and fat free mass (%). This study demonstrates that patients with active IBD have higher serum ghrelin levels than patients in remission and high levels of circulating ghrelin correlate with the severity of disease and the activity markers. Ghrelin levels in inflammatory bowel disease (IBD) patients show an appositive correlation with IGF-1 and bioelectrical impedance analysis, body composition, and anthropometric assessments. Finally, we arrived at the conclusion that ghrelin level may be important in determination of the activity in IBD patients and evaluation of nutritional status.
Asunto(s)
Colitis Ulcerosa/sangre , Enfermedad de Crohn/sangre , Ghrelina/sangre , Estado Nutricional , Adulto , Antiinflamatorios/uso terapéutico , Biomarcadores/sangre , Sedimentación Sanguínea , Composición Corporal , Proteína C-Reactiva/metabolismo , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/fisiopatología , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/fisiopatología , Impedancia Eléctrica , Femenino , Fibrinógeno/metabolismo , Fármacos Gastrointestinales/uso terapéutico , Hormona de Crecimiento Humana/sangre , Humanos , Factor I del Crecimiento Similar a la Insulina/metabolismo , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: Helicobacter pylori eradication rates have tended to decrease recently possibly related with increasing antibiotic resistance. The present study investigated the efficacy of three different ranitidine bismuth citrate (RBC) based triple regimens in a population with high prevalence of H. pylori. METHODS: 300 consecutive H. pylori positive patients with non-ulcer dyspepsia were randomized into three regimens: (1) RBC 400 mg, amoxicillin 1000 mg and tetracycline 500 mg [RBC-AT], (2) RBC 400 mg, amoxicillin 1000 mg and clarithromycin 500 mg [RBC-AC], (3) RBC 400 mg, metronidazole 500 mg and tetracycline 500 mg [RBC-MT]. Tetracycline was given q.i.d, all other drugs were given b.i.d. for 14 days. Gastroscopy and (14)C-Urea breath test (UBT) were performed before enrollment and UBT only was repeated 6 weeks after the end of treatment. RESULTS: 274 patients completed the protocols. The overall 'intention to treat' and 'per protocol' H. pylori eradication rates in all subjects were 57.6% (95% CI: 52-63) and 63.1% (95% CI: 57-68), respectively. The eradication rates achieved in the groups (RBC-AT, RBC-AC and RBC-MT) were 64.4% (95% CI: 54-74), 66.2% (95% CI: 56-76), and 58.9% (95% CI: 49-68) on 'per protocol' analyses, respectively. There was no difference in eradication rates, compliance and major side effects between the groups. CONCLUSION: The current RBC-based H. pylori eradication therapy is not adequately effective.
Asunto(s)
Antibacterianos/administración & dosificación , Antiulcerosos/administración & dosificación , Bismuto/administración & dosificación , Dispepsia/tratamiento farmacológico , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Ranitidina/análogos & derivados , Adolescente , Adulto , Anciano , Amoxicilina/administración & dosificación , Pruebas Respiratorias , Claritromicina/administración & dosificación , Quimioterapia Combinada , Dispepsia/microbiología , Femenino , Gastroscopía , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/microbiología , Humanos , Masculino , Metronidazol/administración & dosificación , Persona de Mediana Edad , Ranitidina/administración & dosificación , Tetraciclina/administración & dosificación , Resultado del TratamientoRESUMEN
It is very difficult to determine and treat injury of the main pancreatic duct and its outcomes secondary to blunt abdominal trauma. In this study, we present a 21-year-old male patient with percutaneous pancreatic fistula due to blunt pancreatic damage. We defined the pancreatic duct disruption along with contrast media leakage by means of endoscopic retrograde pancreatography. A pancreatic duct stent placed after a nasopancreatic catheter was left for 10 weeks. Closure of the fistula along with pancreatic duct improvement without any additional morbidity was observed after removal of the stent.
Asunto(s)
Traumatismos Abdominales/cirugía , Endoscopía , Fístula/cirugía , Conductos Pancreáticos/lesiones , Heridas no Penetrantes/cirugía , Traumatismos Abdominales/complicaciones , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Conductos Pancreáticos/cirugía , Stents , Heridas no Penetrantes/complicacionesRESUMEN
AIM: To investigate the prevalence of celiac disease serologic markers (antigliadin IgA, IgG, and anti-endomysial IgA) in patients with reflux esophagitis and to detect the relationship between reflux esophagitis and celiac disease (CD). METHODS: This study was performed prospectively between January 2003 and January 2004. Sixty-eight adult reflux esophagitis patients and 40 people as control group for symptoms related with gastrointestinal system were enrolled in this study. The diagnostic work-up included an accurate medical history with gastrointestinal symptoms, routine laboratory measurements, the detection of antibodies against gliadin (IgA and IgG) and endomysium (IgA), and an upper endoscopy with postbulbar biopsy. RESULTS: IgA-AGA and IgG-AGA were positive at 8.8% and 10.3% in patients with reflux esophagitis. In control group, it was found that 10% people had positive IgA-AGA, and 7.5% people had positive IgG-AGA. There was no significant relationship between patients and control group regarding positive IgA-AGA and IgG-AGA. The patients and persons in control group had no positive IgA-EMA. On postbulbar biopsies, no finding was detected concerning celiac disease. There were no symptoms and signs for gluten enteropathy in patients and control group. CONCLUSION: This review supports that an association does not exist between celiac disease and reflux esophagitis. We think these diseases exist independently from each other.
Asunto(s)
Enfermedad Celíaca/sangre , Esofagitis Péptica/sangre , Gliadina/inmunología , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Adulto , Anciano , Estudios de Casos y Controles , Enfermedad Celíaca/complicaciones , Ensayo de Inmunoadsorción Enzimática , Esofagitis Péptica/complicaciones , Femenino , Humanos , Inmunoglobulina A/inmunología , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
We describe an axonal motor polyneuropathy in a patient with ulcerative colitis. Symptoms of neuropathy occurred during active colitis. Electrophysiological study showed motor axonal degeneration. After treatment with steroid added to mesalazine, the patient had a gastrointestinal recovery and neurological symptoms were improved. Axonal motor polyneuropathy is an unusual extraintestinal manifestation of ulcerative colitis, and is probably associated with an autoimmune process.
Asunto(s)
Colitis Ulcerosa/complicaciones , Polineuropatías/etiología , Colitis Ulcerosa/inmunología , Colitis Ulcerosa/fisiopatología , Potenciales Evocados Somatosensoriales , Humanos , Masculino , Nervio Mediano/fisiopatología , Persona de Mediana Edad , Conducción Nerviosa , Nervio Peroneo/fisiopatología , Polineuropatías/inmunología , Polineuropatías/fisiopatología , Nervio Tibial/fisiopatologíaRESUMEN
BACKGROUND AND STUDY AIMS: Caustic ingestion caused by swallowing a detergent can produce a progressive and devastating injury in the esophagus and stomach. One of the most important outcomes of the corrosive oesophagitis is the stricture formation, which is resistant to treatment. The aim of this study was firstly to determine the relation between agent, inflammation and stricture, and secondly investigate the efficiency of dilation in patients having esophageal stricture due to corrosive oesophagitis. PATIENTS AND METHODS: In this study, 58 cases with post caustic oesophagitis, which had been admitted to our clinic or emergency department between January 1999 and December 2004, were assessed retrospectively. Dilation of esophageal stricture of the cases was performed by Savary-Gilliard bougies. RESULTS: The most frequently ingested substance was alkaline (48.2%). Concerning all the patients, the most frequent location of caustic injury was upper esophagus (36.2%), and grade I injury was the most frequently encountered one (34.4%). Thirty patients (51.7%) developing stricture were treated by repeated dilations. The most common location of stricture was middle esophagus (50%), and severe stricture was the most common one among all stricture grades (46.7%). Alkaline ingestions yielded more severe stricture than acids. Eight of the patients with stricture (26.6%, 8/30), who didn't respond to periodic esophageal dilation, underwent esophageal resection or bypass surgery. CONCLUSION: Dilation with Savary-Gilliard bougies is a quite effective method for stricture after corrosive oesophagitis.
Asunto(s)
Quemaduras Químicas/complicaciones , Cáusticos/toxicidad , Estenosis Esofágica/inducido químicamente , Esófago/lesiones , Adulto , Dilatación/métodos , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/terapia , Esofagoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Patients with Klinefelter's syndrome have a higher incidence of diabetes mellitus and the percentage of insulin resistance was reported to be high in these patients. However, little is known about the insulin sensitivity assessed by the hyperinsulinemic euglycemic clamp in these patients. In the present study, subjects included 13 newly diagnosed patients with Klinefelter's syndrome, and 9 age- and body mass index-matched healthy males. The hyperinsulinemic euglycemic clamp was performed in all patients and controls. Insulin resistance was present in five (38.5%) patients with Klinefelter's syndrome. Compared with control subjects, patients with Klinefelter's syndrome had elevated plasma concentrations of fasting insulin, follicle-stimulating hormone, luteinizing hormone, estradiol, and sex hormone-binding globulin, whereas they had reduced plasma free testosterone and total testosterone concentrations. The multivariate linear regression analysis showed that fasting glucose, fasting insulin, free testosterone, and total testosterone were independently associated with M-value. In conclusion, the present study by using hyperinsulinemic euglycemic clamp indicates the high prevalence of insulin resistance in Klinefelter's syndrome patients. However, these patients did not have reduced mean M-values compared with the controls, although their plasma insulin levels were significantly elevated. It is possible that hyperinsulinemia may be the primary metabolic abnormality rather than insulin resistance.
Asunto(s)
Resistencia a la Insulina/fisiología , Síndrome de Klinefelter/fisiopatología , Adulto , Índice de Masa Corporal , Técnica de Clampeo de la Glucosa , Hormonas Esteroides Gonadales/sangre , Humanos , MasculinoRESUMEN
BACKGROUND: Although steatosis is common in patients with severe hyperhomocysteinemia due to deficiency of cystathionine beta-synthase, there are no satisfactory data on homocysteine concentrations in patients with non-alcoholic fatty liver disease. The main aim of the present study was to evaluate the clinical significance of plasma homocysteine concentrations in patients with non-alcoholic fatty liver disease. METHODS: Seventy-one non-alcoholic fatty liver disease patients, 36 patients with chronic viral hepatitis and 30 healthy persons were enrolled in the study. Homocysteine levels were measured by high-performance liquid chromatography. Insulin, folate, vitamin B(12) and lipoprotein levels were also determined in all groups. RESULTS: Homocysteine in the non-alcoholic fatty liver disease group was found to be significantly higher than other groups. Homocysteine was found to be significantly higher in the non-alcoholic steatohepatitis group when compared with simple steatosis group. A positive correlation was found between homocysteine and triglyceride, very-low-density-lipoprotein (VLDL) cholesterol, insulin, and index of insulin resistance in the non-alcoholic fatty liver disease group, and a negative correlation was found between homocysteine and folate, or vitamin B(12) in all groups. The homocysteine threshold for the prediction of steatohepatitis was 11.935 ng/mL. Furthermore; plasma homocysteine was a statistically significant predictor for severity of necroinflammatory activity in non-alcoholic steatohepatitis. CONCLUSIONS: The plasma homocysteine concentrations were significantly higher in patients with non-alcoholic fatty liver disease, while the concentrations were not affected by chronic viral hepatitis. Plasma homocysteine is a parameter for discriminating steatohepatitis from simple steatosis. Determining the plasma homocysteine concentrations may facilitate selection of steatosis patients in whom a liver biopsy should be performed.
Asunto(s)
Hígado Graso/fisiopatología , Hepatitis/etiología , Homocisteína/efectos adversos , Adulto , Hígado Graso/sangre , Hígado Graso/etiología , Femenino , Hepatitis/sangre , Hepatitis/fisiopatología , Homocisteína/sangre , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Since it was described in 1980, percutaneous endoscopic gastrostomy (PEG) has been a widely used method for insertion of a gastrostomy tube in patients who are unable to swallow or maintain adequate nutrition. The aim of the present paper was to determine the complications of PEG insertion and to study pre- and post-procedural nutritional status. METHODS: During the period of March 1999-September 2004, placement of PEG tube was performed in 85 patients (22 women and 63 men). Patient nutritional status was assessed before and after PEG insertion via anthropometric measurements. RESULTS: The most frequent indication for PEG insertion was neurological disorders (65.9%). Thirty patients died due to primary disease and two patients due to PEG-related complications within 5 years. There were 14 early complications in 10 patients (15.2%; <30 days), and 18 late complications in 12 patients (19.6%). Total mortality was 37.6%. All complications other than four were minor. Before PEG insertion, patients were assessed with subjective global assessment and it was determined that 43.2% of them had severe, and 41.9% of them had mild malnutrition. After PEG insertion, significant improvements on patient nutrition levels was observed. CONCLUSION: Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low morbidity and mortality rates, is easy to follow up and easy to replace when clogged.
Asunto(s)
Trastornos de Deglución/terapia , Endoscopios Gastrointestinales , Nutrición Enteral/instrumentación , Gastrostomía/instrumentación , Estado Nutricional , Adulto , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/metabolismo , Trastornos de Deglución/mortalidad , Nutrición Enteral/mortalidad , Femenino , Estudios de Seguimiento , Gastrostomía/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia/tendencias , Resultado del TratamientoRESUMEN
BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) procedure is quite difficult to perform in patients with Billroth II anastomosis because of anatomical alterations. The aim of this study is to evaluate retrospectively the results of ERCP applications done in patients with Billroth II operation. METHODOLOGY: Out of the 1632 patients who underwent ERCP between 1992 and 2002, 27 (1.65%) had Billroth II operation. The records of these 27 patients were reviewed. Details noted included indications for ERCP, therapeutic interventions, causes of failure and complications. RESULTS: Out of the patients, 3 were female and 24 male (mean age 62+/-11). 26 patients had extrahepatic biliary obstruction. 1 patient had an external bile drain. The procedure was carried out 1-5 times (mean 1.5+/-1.1). Cannulation was achieved in 17 patients (62.96%). Out of the patients cannulated, 10 had choledocholithiasis, 4 malign choledochal stricture, 1 chronic pancreatitis, 1 bile leak and 1 periampullary tumor. Success rate of endoscopic treatment was 82.35% (14/17). Proximal migration of the stent and hemorrhage in gastric cardia were the complications observed in the distinct patients. CONCLUSIONS: ERCP procedure is quite an effective and safe method for diagnosis and treatment in patients with Billroth II anastomosis and extrahepatic cholestasis in spite of all difficulties.
Asunto(s)
Enfermedades de las Vías Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica , Gastroenterostomía , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de las Vías Biliares/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Femenino , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents/efectos adversos , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
OBJECTIVES: As acylation stimulating protein (ASP) acts on adipocytes mainly as a paracrine factor to increase triglyceride synthesis and storage; hypothetically, it may play a similar role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). METHODS: Forty-six male patients with NAFLD (group A), age-matched 30 male patients with chronic viral hepatitis (group B) and 30 age-matched and body mass index (BMI)-matched healthy male subjects were enrolled in the study. RESULTS: Among the NAFLD patients, 10 patients (24.4%) had simple steatosis and 36 patients (69.6%) had nonalcoholic steatohepatitis (NASH). The mean levels of ASP, complement 3, insulin, C-peptide, HOMA-IR, triglyceride, and very low-density lipoprotein (VLDL) were significantly higher in group A patients than both controls and group B. ASP levels correlated significantly in a positive manner with BMI, insulin, and HOMA-IR. CONCLUSIONS: Dysregulation of the ASP pathway may have important metabolic consequences in NASH and is associated with insulin resistance.
Asunto(s)
Complemento C3a/análogos & derivados , Complemento C3a/metabolismo , Hígado Graso/fisiopatología , Resistencia a la Insulina/fisiología , Adipocitos/patología , Adipocitos/fisiología , Adulto , Biopsia con Aguja , Péptido C/sangre , Complemento C3/metabolismo , Hígado Graso/diagnóstico , Hígado Graso/patología , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/patología , Hepatitis B Crónica/fisiopatología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/patología , Hepatitis C Crónica/fisiopatología , Humanos , Lipoproteínas VLDL/sangre , Hígado/patología , Hígado/fisiopatología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Cirrosis Hepática/fisiopatología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Valores de Referencia , Estadística como Asunto , Triglicéridos/metabolismoRESUMEN
OBJECTIVES: The aim of the present study was to examine the systemic parameters of oxidative stress and antioxidants in patients with nonalcoholic fatty liver disease and investigate the relationship between these parameters and clinical and biochemical outcomes. METHODS: Fifty-one male patients with nonalcoholic fatty liver disease (group I), 30 age-matched and body mass index (BMI)-matched healthy male subjects, and 30 age-matched male patients with chronic viral hepatitis (group II) were enrolled in the study. RESULTS: Increased systemic levels of malondialdehyde and depletion of antioxidants such as coenzyme Q10, CuZn-superoxide dismutase, and catalase activity were observed in group I. Coenzyme Q10 and CuZn-superoxide dismutase correlated negatively with increasing necroinflammatory activity and fibrosis. Body fat was negatively associated with plasma coenzyme Q10 levels, while an inverse association was found between plasma catalase levels and TG. However, LDL was positively associated with plasma malondialdehyde levels. CuZn-superoxide dismutase levels were negatively associated with glucose, insulin, and HOMA-IR. In addition, the levels of CuZn-superoxide dismutase correlated significantly in a negative manner with BMI. CONCLUSIONS: Our results concerning correlations suggest that disturbances in BMI, body fat, and lipid metabolism may contribute to altered oxidative status in NAFLD, and insulin resistance may be related to decreased antioxidants in NAFLD as well as products of lipid peroxidation. However, although our results suggest interesting correlations, this different mostly "weak" relationships must be taken with caution.
Asunto(s)
Antioxidantes/metabolismo , Complemento C3a/análogos & derivados , Hígado Graso/fisiopatología , Resistencia a la Insulina/fisiología , Peroxidación de Lípido/fisiología , Estrés Oxidativo/fisiología , Ubiquinona/análogos & derivados , Adulto , Biomarcadores/sangre , Composición Corporal/fisiología , Índice de Masa Corporal , Catalasa/sangre , Coenzimas , Complemento C3a/metabolismo , Hígado Graso/diagnóstico , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/fisiopatología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/fisiopatología , Humanos , Hígado/fisiopatología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/fisiopatología , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , Valores de Referencia , Estadística como Asunto , Superóxido Dismutasa/sangre , Ubiquinona/sangreRESUMEN
OBJECTIVES: The aim of this study was to relate urine levels of neopterin, a marker of activation of the cellular immune system, with grading and staging of NASH. DESIGN AND METHODS: Urine concentrations of neopterin, routine tests, insulin and C-peptide levels were assessed in 50 patients with NASH, 25 patients with chronic viral hepatitis (CVH), and in 26 healthy controls. RESULTS: Urine neopterin levels were found elevated in the NASH and CVH groups compared with controls. There was no significant correlation between urine neopterin levels and inflammation grade in the liver. CONCLUSIONS: Urine neopterin levels are a marker of cellular immunity and are higher in patients with NASH. However, neopterin levels were not significantly associated with histopathological grade and stage of disease.
Asunto(s)
Hígado Graso/patología , Neopterin/orina , Adulto , Biomarcadores/orina , Estudios de Casos y Controles , Pruebas Enzimáticas Clínicas , Hígado Graso/diagnóstico , Hígado Graso/orina , Femenino , Hepatitis Viral Humana/orina , Humanos , Inflamación/patología , Masculino , Persona de Mediana EdadRESUMEN
Considerable discrepancies exist in the literature with respect to plasma total homocysteine (tHcy) levels in Behçet's disease (BD). The aim of this study was to evaluate tHcy concentrations in these patients. Thirty-two patients with BD and 20 age- and body mass index-matched healthy volunteers were enrolled. Plasma tHcy concentrations were significantly higher, while vitamin B12 and folate levels were significantly lower in patients with thrombosis and eye involvement than those without. C-reactive protein levels also correlated significantly in a negative manner with vitamin B12 and folate but positively with tHcy. In conclusion, increased use or accelerated catabolism of folate and vitamin B12 due to chronic inflammation and moderately increased tHcy concentrations related with deficiency of these cofactors, and immunosuppressive drug administration might be potential threats of vascular disease in BD.
Asunto(s)
Síndrome de Behçet/complicaciones , Proteína C-Reactiva/metabolismo , Homocisteína/sangre , Hiperhomocisteinemia/etiología , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Síndrome de Behçet/sangre , Síndrome de Behçet/tratamiento farmacológico , Síndrome de Behçet/patología , Colchicina/uso terapéutico , Quimioterapia Combinada , Oftalmopatías/etiología , Oftalmopatías/patología , Femenino , Ácido Fólico/sangre , Glucocorticoides/uso terapéutico , Humanos , Hiperhomocisteinemia/patología , Inmunosupresores/uso terapéutico , Masculino , Trombosis/etiología , Trombosis/patología , Vitamina B 12/sangreRESUMEN
Familial Mediterranean fever (FMF) is a recessively inherited inflammatory disorder, characterized by recurrent attacks of fever and polyserositis. It has been considered that miscellaneous cytokines take part in the pathogenesis of the disease. The aim of this study was to investigate serum levels of soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients with FMF. The study included 42 patients with FMF (3 females, 39 males, mean age: 24.43 years) and 20 healthy volunteers as the control group (18 males, 2 females, mean age: 23.2 years). The patients were chosen according to Eliakim criteria. After recording their history and performing an examination, leukocyte counts, erythrocyte sedimentation rates (ESR), C-reactive protein (CRP), fibrinogen, sIL-2R, IL-6, and IL-10 levels were measured before and during attacks. A significant increase was found in leukocyte ( p<0.001), ESR ( p<0.001), CRP ( p<0.001), and fibrinogen ( p<0.001) levels of the patient group in the attack period compared to those in the quiescent state. sIL-2R ( p=0.019) and IL-6 ( p<0.001) levels showed significant increases during attacks compared to the levels before an attack. There was no significant difference between IL-10 levels. The levels of the three cytokines were significantly high both before and during the attacks compared to the control group. As a result, the elevation of sIL-2R and IL-6 levels both before and during the attacks compared to control group suggests the existence of continuous cytokine activation in the patients. No significant increase in the IL-10 levels in spite of the significant rise of sIL-2R and IL-6 during attacks supports the notion of inflammation and also reveals that compensation by anti-inflammatory IL-10 does not seem to occur.