[Show abstract][Hide abstract] ABSTRACT: Thromboembolic events represent a major cause of morbidity and mortality in patients with inflammatory bowel disease and they may occur both at the gastrointestinal tract and at extraintestinal sites. This study aimed to examine the alterations in coagulation parameters involved at different steps of hemostasis in patients with Crohn's disease and ulcerative colitis, in comparison with healthy individuals. Fifty-one patients with inflammatory bowel dis-ease and 26 healthy controls were included in this study. Plasma levels of PT, APTT, AT III, plasminogen, fibrinogen, D-dimer, factor V, factor VIII, protein C, protein S, and APCR were measured and factor V Leiden mutation was ex-amined in both patients and controls. Two patients with ulcerative colitis had a history of previous thromboembolic event. Inflammatory bowel disease was associated with significantly higher levels of fibrinogen, PT, factor V, factor VIII, plasminogen and thrombocyte. Protein S, fibrinogen, plasminogen and thrombocyte levels were associated with disease activity, depending on the type of the disease (Crohn's disease or ulcerative colitis). The coagulation abnor-malities detected in this study seems to be a secondary phenomena resulting from the disease process, which is more likely to be associated with a multitude of factors rather than a single abnormality. Introduction Inflammatory bowel disease is a group of disor-ders associated with chronic, recurrent, and immune system-mediated inflammation of the bowel mucosa . The reported global inci-dence and prevalence rates for ulcerative coli-tis vary between 1.2-20.3 and 6-246 per 100 000 persons, respectively, and the correspond-ing figures for Crohn's disease are 0.03-15.6 and 3.6-214 . In a population based cohort study involving 1160 patients with ulcerative colitis, the complication-related mortality rate was 9.6% during a follow-up period of 35 years,  in another study, 221 patients with Crohn's disease were followed up for 33 years, with an overall complication-related mortality rate of 7.7% . Of the extra-intestinal manifestations of inflam-matory bowel disease (IBD), thromboembolic events represent a major cause of morbidity and mortality  with a 3.6 times increased risk in comparison with the general population . Although clinical observations suggest an inci-dence rate between 1 and 8% for thromboem-bolic events in subjects with IBD, [5-7] postmor-tem studies point out to a much higher occurrence rate around 41% . As a matter of fact, these and similar findings have led to an increased interest in the search for the associa-tion between IBD and hypercoagulable states as a potential cause of increased morbidity and mortality due to thromboembolic events in IBD [5, 9]. For instance, the existence of document-able prothrombotic abnormalities and a posi-tive history for thromboembolic complications
[Show abstract][Hide abstract] ABSTRACT: Thromboembolic events represent a major cause of morbidity and mortality in patients with inflammatory bowel disease and they may occur both at the gastrointestinal tract and at extraintestinal sites. This study aimed to examine the alterations in coagulation parameters involved at different steps of hemostasis in patients with Crohn's disease and ulcerative colitis, in comparison with healthy individuals. Fifty-one patients with inflammatory bowel disease and 26 healthy controls were included in this study. Plasma levels of PT, APTT, AT III, plasminogen, fibrinogen, D-dimer, factor V, factor VIII, protein C, protein S, and APCR were measured and factor V Leiden mutation was examined in both patients and controls. Two patients with ulcerative colitis had a history of previous thromboembolic event. Inflammatory bowel disease was associated with significantly higher levels of fibrinogen, PT, factor V, factor VIII, plasminogen and thrombocyte. Protein S, fibrinogen, plasminogen and thrombocyte levels were associated with disease activity, depending on the type of the disease (Crohn's disease or ulcerative colitis). The coagulation abnormalities detected in this study seems to be a secondary phenomena resulting from the disease process, which is more likely to be associated with a multitude of factors rather than a single abnormality.
International Journal of Clinical and Experimental Medicine 01/2014; 7(5):1442-8. · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sequential treatment scheme has been developed to overcome resistance problem in H. pylori eradication and favorable results have been obtained. This study compared the results of standard triple therapy with a sequential schema consisting of pantoprazole, amoxicillin, clarithromycin, and metronidazole in a high anti-microbial resistance setting. This retrospective study included subjects that underwent standard or sequential eradication treatment after a diagnosis of biopsy-documented H. pylori infection. Patients either received pantoprazole 40 mg bid, amoxicillin 1000 mg bid and clarithromycin 500 mg bid (PAC) for 10 days, or pantoprazole 40 mg bid and amoxicillin 1000 mg bid (PA) for the first 5 days of the treatment period and were then given pantoprazole 40 mg bid, clarithromycin 500 mg bid, and metronidazole 500 mg bid (PCM) in the remaining 5 days. Eradication was tested using urea breath test. The two treatment groups did not differ with regard to H. pylori eradication rate for both ITT population (63.9% versus 71.4% for standard and sequential therapy respectively, P = 0.278) and per protocol population (65.9% versus 74.1% for standard and sequential therapy respectively, P = 0.248). Although a sequential treatment appears to represent a plausible alternative, our findings suggest that alternative schedules may be required in certain populations to achieve higher success rates.
International Journal of Clinical and Experimental Medicine 01/2014; 7(8):2324-8. · 1.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the effects of methylene blue (MB) on the early and late phases of adhesion and abscess formation in a standard colonic wall injury and fecal peritonitis model in rats.
There were four groups: Group I (only laparotomy, n=10), Group II (peritonitis + MB, n=15), Group III (peritonitis + saline, n=15), and Group IV (colon incision + saline, n=15). Mortality, morbidity, adhesion scores, histopathologic analyses, serum tumor necrosis factor-alpha (TNF-?) levels, and tissue hydroxyproline (5-HP) levels were evaluated in all animals. Descriptive statistical methods were used with Kruskal-Wallis test. When a statistical difference was obtained between groups, Mann-Whitney U test was used to confirm the difference between two groups.
Adhesion scores of Groups I, III and IV were significantly higher than in Group II. TNF-? levels were significantly higher in Groups I, III and IV. 5-HP levels were significantly lower in Groups I and II compared to Groups III and IV.
Based on these results, it appears that MB may prevent peritoneal adhesions in a peritonitis model, but wound healing could be impaired. MB should be further evaluated because of its dual effect.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 05/2011; 17(3):205-9. · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In inflammatory bowel disease (IBD) number of thromboembolic events are increased due to hypercoagulupathy and platelet activation. Increases in mean platelet volume (MPV) can lead to platelet activation, this leads to thromboembolic events and can cause acute coronary syndromes. In IBD patients, QT-dispersion and P-wave dispersion are predictors of ventricular arrhythmias and atrial fibrilation; MPV is accepted as a risk factor for acute coronary syndromes, we aimed at evaluating the correlations of these with the duration of disease, its localization and activity.
The study group consisted of 69 IBD (Ulcerative colitis n: 54, Crohn's Disease n: 15) patients and the control group included 38 healthy individuals. Disease activity was evaluated both endoscopically and clinically. Patients with existing cardiac conditions, those using QT prolonging medications and having systemic diseases, anemia and electrolyte imbalances were excluded from the study. QT-dispersion, P-wave dispersion and MPV values of both groups were compared with disease activity, its localization, duration of disease and the antibiotics used.
The P-wave dispersion values of the study group were significantly higher than those of the control group. Duration of the disease was not associated with QT-dispersion, and MPV levels. QT-dispersion, P-wave dispersion, MPV and platelet count levels were similar between the active and in mild ulcerative colitis patients. QT-dispersion levels were similar between IBD patients and the control group. No difference was observed between P-wave dispersion, QT-dispersion and MPV values; with regards to disease duration, disease activity, and localization in the study group (p>0.05).
P-wave dispersion which is accepted as a risk factor for the development of atrial fibirilation was found to be high in our IBD patients. This demonstrates us that the risk of developing atrial fibrillation may be high in patients with IBD. No significant difference was found in the QT-dispersion, and in the MPV values when compared to the control group.
International journal of medical sciences 01/2011; 8(7):540-6. · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the relationship between the apparent diffusion coefficient (ADC) values of the colonic wall and the pathologic pericolonic lymph nodes (PCLNs) and inflammatory activity in ulcerative colitis patients by diffusion-weighted magnetic resonance imaging (DW-MRI).
A total of 28 ulcerative colitis patients (9 endoscopically active, 10 subacute and 9 in remission) were evaluated by DW-MRI with 0, 500 and 1000 s/mm² b-values. The ADC values of the rectum and sigmoid colon walls and the adjacent PCLNs were obtained for quantitative analysis. The DW-MRI findings were compared to the disease activity.
The ADC values of the sigmoid colon were similar in patients with active, subacute and remissive ulcerative colitis (P = 0.472). The ADC values of the rectum were different (P = 0.009) between patients in the active (1.08 ± 0.14×10⁻³ mm²/s) and subacute phases (1.13 ± 0.23×10⁻³ mm²/s) of disease and those in remission (1.29 ± 0.17×10⁻³ mm²/s). The ADC values of the PCLNs (P = 0.899) did not differ with respect to disease activity.
DW-MRI is useful in identifying disease activity in ulcerative colitis patients, especially with respect to the rectum. The ADC values of the rectum increase during remission and decrease in patients with active distal colitis. The ADC values of the PCLNs were not useful in determining disease activity.
[Show abstract][Hide abstract] ABSTRACT: We evaluated the utility of quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) for assessing both the relationship between the degree of fibrosis and the histological activity index (HAI) in chronic hepatitis (CH) cases and attempted to determine whether the apparent diffusion coefficient value (ADC) could be used as a reference for the degree of fibrosis detected by histology.
The study population consisted of 55 CH patients (Group I) and a control group of 30 volunteers (Group II). Group I consisted of 31 CH-B (CHB), 18 CH-C (CHC) and 6 non-alcoholic steatohepatitis patients. DW-MRI of the liver with b values of 0, 500 and 1000 s/mm(2) was performed, and liver biopsies of the patients were obtained two weeks later. The ADC value, degree of liver fibrosis and HAI were compared within Group I, and the ADC values of both groups were compared with each other.
The ADC was lower in Group I than in Group II (P < 0.05). The ADC of the left lobe lateral (LL) (P < 0.05), left lobe medial (LM) and right lobe anterior (RA) segments (P < 0.01) in Group I were lower than those of Group II. There was no relationship between HAI and the ADC of LL, LM, RA and right lobe posterior (RP) segments in Group I. Additionally, there was no correlation between fibrosis scores and ADC in Group I, whereas there was a negative correlation between fibrosis scores and ADC values of the LL (28.3%) and RP (29.5%).
CH patients had lower ADC values. There was no correlation between ADC values and fibrosis stages or ADC and HAI values. Quantitative DW-MRI was not useful in determining the degree of fibrosis in liver tissue.
[Show abstract][Hide abstract] ABSTRACT: Bile leakage is a common complication of cholecystectomy. The aim of this study was to compare endoscopic sphincterotomy (EST) and biliary stenting (BS) in the treatment of bile leaks after cholecystectomy.
Twenty-seven patients with bile leakage following cholecystectomy underwent endoscopic retrograde cholangiography (ERCP). Patients were randomized into two groups (EST and BS +/- EST), according to the initial therapeutic endoscopic intervention. The patients were allocated into subgroups once more, according to diameter of the common bile duct (CBD). Outcomes and efficacy of BS and EST on fistula closure and the time to fistula closure were investigated.
The median time between cholecystectomy and ERCP in the EST and BS groups was 6.45 +/- 3.41 and 4.50 +/- 1.99 days, respectively. The mean daily amount of biliary leakage in the EST and BS groups was 376.92 +/- 243.77 and 441.07 +/- 216.08 cc/day, respectively. The diameter of the distal part of CBD in the EST and BS groups was 9.07 +/- 3.84 and 8.28 +/- 4.04 mm, respectively. Mean fistula closure was achieved in 6.45 +/- 3.41 in 11 of 13 patients in the EST group and 4.50 +/- 1.99 days in the BS group in all patients. However, mean time of closure was significantly shorter in the BS 4.71 +/- 2.14 group, compared to EST (9.67 +/- 2.51), among patients with distal CBD diameter (< or =8 mm).
BS seems to be a more effective method than EST in the management of postcholecystectomy among patients with bile leakage and without CBD dilatation. BS might be the first-line treatment among such patients. However, further prospective, randomized, clinical trials regarding CBD dilatation are warranted.
[Show abstract][Hide abstract] ABSTRACT: To investigate intra-abdominal, local histopathological and hemostatic effects of Ankaferd (ABS) in an experimental liver injury.
Forty rats were randomly assigned to the primary suture group (PS) (n = 15), ABS group (n = 15) and control group (n = 10). A wedge resection was performed on the left lobe of the liver. In the primary suture group, the liver was sutured with polypropylene material, while in ABS group the liver surface was covered with ABS. Adhesion, histo-pathological scores and hydroxyproline levels were measured postoperatively on day 3 and day 15.
The mean bleeding time was 7.5 sec shorter in the ABS group (6.5 sec-13.5 sec) and 107 sec shorter in PS group. AST, ALT, total bilirubin and ALP values complete blood count (CBC) did not change. Intra-abdominal adhesions were the same in PS and ABS groups on 3rd (2.20 +/- 1.30 vs 2.0 +/- 1.11) and 15th (1.60 +/- 0.54 vs 1.25 +/- 0.7) days postoperatively. Histopathological scores were better in the ABS group than in the primary suture group on 3rd (2.5 +/- 0.5 vs 5.25 +/- 0.2, p = 0.006) and 15th (1.65 +/- 1.7 vs 3.15 +/- 1.0, p = 0.025) days postoperatively. Hydroxyproline levels were higher in ABS group on postoperative 15th day (17.12 microg/tissue vs 13.69 microg/tissue; p = 0.005).
These data suggest that ABS in experimental liver trauma causes favorable histopathological scores and shorter hemostasis time and higher hydroxyproline levels (Tab. 2, Fig. 2, Ref. 35).
Bratislavske lekarske listy 01/2010; 111(4):183-8. · 0.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Congestive hepatomegaly might be the first sign for pulmonary hypertension. Apparent diffusion coefficient (ADC) value obtained with quantitative diffusion-weighted magnetic resonance imaging (DW-MRI) is affected by liver fibrosis and perfusion. We aimed to evaluate the diagnostic value of DW-MRI in cooperation with biochemical markers, ultrasonography (US) and echocardiography (TTE) in determining the degree of hepatic congestion secondary to pulmonary hypertension (PHT).
35 patients with PHT and 26 control subjects were included in the study. PHT was diagnosed if pulmonary artery systolic pressure (PASP) was measured above 35 mmHg with TTE. Study group was classified into mild and moderate PHT. DW-MRI was performed with b-factors of 0, 500 and 1000 sec/mm(2). Mean ADC, ADC-II (Average of the ADC values of right lobe anterior and posterior segments), US, TTE and blood biochemical parameters of both groups were compared.
There exists a positive correlation between liver size and the diameters of vena cava inferior, right atrium, right hepatic vein(RHV), mid-hepatic vein(MHV), left hepatic vein(LHV) (p < 0.01). There was a positive correlation between PASP and RHV, MHV, LHV. The patients had lower ejection fractions (p < 0.01) and higher LDH (p < 0.01) and ALP (p < 0.05) levels than the control group. The ADC values of the patients with moderate PASP were higher than those with a mild PASP (p < 0.05). Mean ADC was higher in patients with moderate PHT compared to control group (p = 0.009). There was a positive correlation between PASP and ADC values of right lobe posterior segment of the liver (p < 0.05). The ADC-II and mean ADC values of the patients with moderate PASP were higher than those of the control group (p < 0.01).
Congestion due to moderate PHT might be diagnosed with DW-MRI. As PASP increase; mean ADC and ADC-II values increase.
[Show abstract][Hide abstract] ABSTRACT: Intravesical administration of Bacillus Calmette-Guérin is used as a treatment method in superficial bladder cancer. While it is generally well tolerated, serious side effects may develop. Granulomatous hepatitis cases have been previously reported; however, only one case with tuberculous peritonitis exists in the current literature. We hereby present two cases, one of which is the second tubercular peritonitis case following Bacillus Calmette-Guérin treatment to be reported, and the other a case with granulomatous hepatitis. Complete cure was achieved in both cases with specific therapy. In the patient who developed peritonitis, intravesical Bacillus Calmette-Guérin therapy was recommenced after antituberculosis treatment, and completed without further complications.
Annals of Clinical Microbiology and Antimicrobials 05/2009; 8:12. · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dieulafoy lesion is a rare but serious cause of gastrointestinal system bleeding. An aberrant submucosal artery, which was described in 1884, causes the bleeding. The lesion can be located anywhere in the gastrointestinal tract but is most commonly found in the proximal stomach up to 6 cm from the gastroesophageal junction. Increased experience in endoscopy has led to an increased frequency of its proper diagnosis. Various methods are used to achieve successful hemostasis by endoscopy in Dieulafoy lesion; however, comparative studies about the success rates of these methods are still needed. In this study, we compared two of these endoscopic hemostatic methods: band ligation, and injection therapy in Dieulafoy lesions.
In this prospective study, 18 patients admitted to the Emergency Surgical Unit between January 2002 and December 2005 with upper gastrointestinal bleeding diagnosed as Dieulafoy lesion were included. Diagnose of Dieulafoy lesion was made at initial or second-look endoscopy. Patients were randomized in two groups according to therapy method: injection therapy and band ligation groups. Therapy was applied immediately after recognizing the lesion at the same endoscopic procedure. Two groups were compared regarding demographical data, presence of comorbid diseases, history of medication and previous gastrointestinal system bleeding, hemodynamic status, laboratory values, need for transfusion, endoscopic findings, success rate of the treatment method, mean hospital stay, complications, and recurrence of bleeding.
Of 588 patients admitted with upper gastrointestinal hemorrhage, Dieulafoy lesion was recognized in 18 cases (3.1%) at initial or second-look endoscopy. All patients were men with a mean age of 62.8 (range, 30-80) years. Band ligation was applied to ten patients and the remaining eight were treated by injection therapy. During the follow-up period, rebleeding occurred in six of the patients (75%) with injection therapy, whereas no rebleeding occurred for the patients in the band ligation group. The rebleeding rate and mean hospital stay was significantly higher for the injection therapy group.
Our study suggests that of the endoscopic treatment methods, band ligation is superior to injection therapy for the treatment Dieulafoy lesions.
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to determine and evaluate the apparent diffusion coefficient (ADC) values of the rectal wall for identifying inflammatory bowel disease (IBD) and rectosigmoid (rectum and sigmoid colon) malignancies.
Diffusion-weighted magnetic resonance imaging (DWI) findings of 23 patients (mean age, 57 years) consisting of 14 patients with rectosigmoid adenocarcinomas and 9 patients with IBD (6 with ulcerative colitis and 3 with Crohn disease) were retrospectively reviewed. In addition, 30 healthy controls (mean age, 45 years) were enrolled in the study. Diffusion-weighted imaging was performed with b factors of 0, 500, and 1000 s/mm2.
The mean (SD) ADC values of the control, IBD, and rectosigmoid adenocarcinoma groups were 1.47 (0.19) x 10(-3) mm2/s, 1.37 (0.12) x 10(-3) mm2/s, and 0.97 (0.14) x 10(-3) mm2/s, respectively. Among the patients with IBD, 2 were in the active, and the rest were in the inactive period, with mean (SD) ADC values of 1.21 (0.08) x 10(-3) and 1.42 (0.09) x 10(-3), respectively. The ADC values of the normal rectum and rectosigmoid malignancy group and rectosigmoid carcinoma and IBD groups were significantly different (P < 0.01). A cutoff value for carcinomas of 1.14 x 10(-3) mm2/s yielded a sensitivity and specificity of 93.3% and 93.3%, respectively.
Our preliminary findings show that quantitative DWI may be able to differentiate the normal rectum from neoplastic involvement, in addition to distinguishing between inflammatory and neoplastic involvements. However, radiologists should be aware of possible overlaps that may lead to misdiagnoses when DWI is used alone.
[Show abstract][Hide abstract] ABSTRACT: Natural orifice transluminal endoscopic surgery is a novel therapeutic method in development that uses different routes of surgical approach. The use of various methods, instruments and accessories during this procedure are currently being investigated. A case of appendicitis-related intra-abdominal abscess that was resolved by a transcolonic endoscopic approach using a wide-channel colonoscope with the help of precut and standard sphincterotome without radiological percutaneous drainage is presented.
Canadian journal of gastroenterology = Journal canadien de gastroenterologie 01/2009; 22(12):983-6. · 1.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hydatid disease is still a frequently seen disease in endemic area like South America, Middle Asia and South Europe as well as Turkey. Although the disease occurs more frequently in liver and lungs, it can be seen in any part of the body. In this report we present a case of isolated omental hydatid disease which is a rare entity in the English literature.
International Medical Case Reports Journal 01/2009; 2:7-10.
[Show abstract][Hide abstract] ABSTRACT: To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) with respect to some risk factors and patient characteristics.
The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion (group I) with suicidal intent. Thirty patients with or without mild complaints of dyspepsia (group II) were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score (LS), expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis.
Gastroduodenal damage was signifi-cantly more severe in group I compared to group II (P < 0.01). The LS was similar in both groups Ia and Ib. However LS was significantly higher in patients who had ingested multiple NSAIDs (group Ic) compared to other patients (P < 0.01). The LS was correlated to age (P < 0.01) and total amount of drug ingested (P < 0.05) in group I; but it was not correlated with Helicobacter pylori (H pylori) infection or duration of exposure (P > 0.05). The biopsy score (BS) was higher in group I than group II (P < 0.01), and higher in group Ib than group Ia (P < 0.05).
The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of high-dose acetaminophen.
World Journal of Gastroenterology 12/2008; 14(43):6704-10. · 2.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the prevalence of amebiasis in patients with ulcerative colitis residing in two geographical regions with different socioeconomic status and climatic conditions, and its effect on the age of onset, duration, localization, and activity of disease. Ninety patients from a high socioeconomic location (group I) and 28 cases from a low socioeconomic location (group II) were enrolled. Median age at disease onset was significantly higher in group I compared with in group II. Prevalence of amebiasis in group I was significantly lower than in group II. A considerably number of patients with amebiasis in group I had a history of travel to the cities with a lower socioeconomic level, mainly located in the east of Turkey. There was a strong relationship between presence of amebiasis and history of travel to eastern parts of Turkey among residents from the northwestern part of Turkey. Median age and age at time of diagnosis were significantly lower in patients with amebiasis compared with those without infection. In patients with mild disease activity, prevalence of amebiasis was significantly lower compared with those with moderate or severe disease activity. In conclusion, prevalence of amebiasis was markedly higher in the southeast compared to the northwest of Turkey. Travel to regions with low socioeconomic status may be considered a risk factor for amebiasis in patients with ulcerative colitis. Amebiasis enhances disease activity in ulcerative colitis.
Digestive Diseases and Sciences 10/2008; 54(6):1292-6. · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study is to evaluate the serum copper, ceruloplasmin and 24-h urine copper levels in celiac patients. Serum copper, ceruloplasmin and 24-h urine measurements were evaluated in patients with celiac (n = 32), Crohn's (n = 25), Wilson's (n = 11) and in a healthy group (n = 35). Serum and 24-h urine zinc levels, AST, ALT, BUN, creatinine, iron, hemoglobin, hematocrit, lymphocyte, sedimentation and CRP levels were also measured. Results were evaluated statistically and significance was accepted as meaningful if P < 0.05. In celiacs, levels of urine copper were high (52 +/- 29 microg/day, P < 0.000) but serum copper was the same as in controls (105 +/- 16 microg/dl, P < 0.158). High urinary copper of celiacs were coming out in women (56 +/- 30 microg/day) and in man (33 +/- 17 microg/day, P < 0.115). Most celiacs were female (P < 0.001). Serum copper and ceruloplasmin levels in all groups were higher in women than in men and this was meaningful for serum copper in the control group (P < 0.045) and for ceruloplasmin in Crohn's (P < 0.055) and control groups (P < 0.031). Serum (70 +/- 14 microg/dl, P < 0.000) and urine zinc levels (25 +/- 15 microg/dl, P < 0.039) of celiacs were low. Ceruloplasmin levels were higher in celiacs (337 +/- 64 U/1) and Crohn's patients (366 +/- 47 U/l, P < 0.000). Correlations observed in the groups of celiac (P < 0.029) and Crohn's (P < 0.024), celiac and Wilson's (P < 0.001) and Crohn's and Wilson's (P < 0.001) between the ceruloplasmin and 24-h urine copper parameters. AST and ALT levels were higher in celiac and Wilson's patients than in Crohn's patients and controls. Mean CRP levels were significantly higher in Crohn's than others. Lymphocyte counts were meaningfully higher in celiacs. Statistically, while mean iron, hemoglobulin and hematocrit levels of celiac and Crohn groups were meaningfully lower than the normal and Wilson's group, it was similar in Wilson's and the control group. Serum copper (85 +/- 26 microg/dl, P < 0.158) and ceruloplasmin (219 +/- 83 U/l, P < 0.001) levels were low and 24-h urine copper levels were high (415 +/- 346 microg/day) in Wilson's group. Increased urinary loss may be another cause of copper deficiency in female celiacs besides malabsorption and this topic needs more investigation. Increased urinary copper levels in celiac women should not always be regarded as a diagnosis of Wilson's disease.
Digestive Diseases and Sciences 07/2008; 53(6):1564-72. · 2.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ERCP and endoscopic sphincterotomy in patients with Billroth II gastrectomy are technically more difficult due to the reversed anatomy. We developed a new guidewire sphincterotome that includes two 15-mm non-isolated metal parts, one of which is located 12 cm from the distal tip and the other in the proximal end. The aim of this study was to evaluate the feasibility of and outcomes with the new sphincterotome for sphincterotomy in patients with Billroth II gastrectomy.
Between January 2004 and March 2007, 11 patients with Billroth II gastrectomy underwent endoscopic sphincterotomy with the new guidewire sphincterotome. Procedures were initiated by deep cannulation of the bile duct with a standard catheter and guidewire sphincterotome. After cholangiography, the catheter was withdrawn with 0.5 to 1 cm of its tip outside the duodenoscope. The distal non-isolated part of the sphincterotome was placed in the papillary orifice. In order to reach the proper position, the duodenoscope's elevator was moved to the downward position, the up-down dial was turned slightly in the downward direction, and then the duodenoscope was pushed slightly forward. Finally, sphincterotomy was performed in the 6 o'clock direction.
Sphincterotomy with the new sphincterotome was successfully achieved in all patients without using protective pancreatic stents. Seven patients had common bile duct stones, two pancreatitis, one odditis, and another one persistent bile duct leakage. There were no sphincterotomyrelated complications or death during this study.
In this pilot study, endoscopic sphincterotomy with a new guidewire sphincterotome in patients with Billroth II gastrectomy was found to be clinically successful, concise, easy to perform, efficient, and reliable. However, further large comparative studies are needed for a definite conclusion.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 07/2008; 19(2):109-13. · 0.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Non-specific abnormalities in liver function tests might accompany the clinical course of hyperthyroidism. Hyperthyroidism can cause the elevation of hepatic enzymes and bilirubin. Jaundice is rare in overt hyperthyroidism, especially in subclinical hyperthyroidism. On the other hand, the use of anti-thyroid drugs has rarely been associated with toxic hepatitis and cholestatic jaundice.
Here we present two cases of cholestasis that accompanied two distinct forms of clinical hyperthyroidism. The first patient had a clinical presentation of severe cholestasis in the absence of congestive failure related to hyperthyroidism. The second case had developed intrahepatic cholestasis in the presence of subclinical hyperthyroidism, and improved with rifampicin treatment.
Hyperthyroidism should be a consideration in non-specific liver dysfunction.