Comparison of the predictive values of CRP, CRP/albumin, RDW, neutrophil/lymphocyte, and platelet/lymphocyte levels in determining the severity of acute pancreatitis in patients with acute pancreatitis according to the BISAP score.

BACKGROUND: In our study, it was aimed to find out whether it would be possible to determine the disease severity by comparing the values of red cell distribution width (RDW), c-reactive protein (CRP), CRP/albumin, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) in patients with acute pancreatitis according to Bedside Index of Severity in Acute Pancreatitis (BISAP) scores at the time of admission. METHODS: Five hundred patients diagnosed with acute pancreatitis were included in the study. RESULTS: According to BISAP scores, 388 (77.6 %) patients were evaluated as having mild acute pancreatitis and 112 (22.4 %) patients as having severe acute pancreatitis. In ROC analysis, values of 70.54 % sensitivity and 70.10 % specificity for CRP, 71.43 % sensitivity and 70.88 % specificity for CRP/albumin, 80.36 % sensitivity and 30.30 % specificity for RDW, 75.00 % sensitivity and 43.98 % specificity for NLR, and 55.36 % sensitivity and 38.51 % specificity for PLR were determined. Values of 85.71 % sensitivity and 66.49 % specificity were determined for the NLR-CRP/Albumin-RDW 2** score as a newly created scoring system. CONCLUSION: CRP/albumin, NLR, PLR, and RDW values ​​were found to be statistically significantly higher in patients with severe acute pancreatitis compared to those with mild acute pancreatitis according to the BISAP score (pthat this scoring system could be a practical and reliable guide in the treatment and follow-up of patients with acute pancreatitis (Tab. 6, Fig. 3, Ref. 22).

Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography?

BACKGROUND AND STUDY AIM: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. PATIENTS AND METHODS: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. RESULTS: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). CONCLUSIONS: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

Myxoma complicated acute intestinal obstruction: A rare case with diagnostic challenges.

Myxomas are slowly growing mesenchymal tumors and are considered as extremely rare benign tumors of small intestine. This is the case of a young woman presenting with acute bowel obstruction due to ileo-ileal intussusception caused by an intraluminal 4- cm solitary nodule, found to be a myxoma upon pathologic examination, after resection by surgery.

Predictive Value of Neutrophil-to-Lymphocyte Ratio for Differentiating Organic Dyspepsia from Functional Dyspepsia

ABSTRACT Objective: Dyspepsia, one of the most commonly seen symptoms, can be due to organic dyspepsia (OD) or functional dyspepsia (FD). The aim of this study is to evaluate neutrophil-tolymphocyte ratio (NLR) for the predictability of OD due to peptic ulcer disease (PUD) and gastric cancer (GC). Methods: We investigated retrospectively the patients with dyspepsia who underwent endos-copy. The study included 119 patients with OD (41 patients with biopsy-proven GC and 78 patients with PUD) and 100 patients with FD diagnosed. Results: The NLR among the patients with GC and PUD was significantly higher than FD subject (p < 0.001 each). The NLR in patients with GC was also significantly higher than that in patients with PUD (p < 0.005). When OD was compared with FD, NLR and white blood cell were statistically significantly higher (p < 0.001 and p < 0.05 respectively). The best predictive cut-off value of NLR was 1.72 with a specificity of 63% and a sensitivity of 66% for OD, on receiver-operating characteristic curve analysis. Conclusion: Neutrophil-to-lymphocyte ratio was higher in patients with OD compared with those with FD, and even higher in patients with GC. Our findings suggest that NLR should be calculated in patients with dyspepsia and patients with high levels of NLR should undergo endoscopy.

Neutrophil-lymphocyte Ratio: Predictor of High-grade Dysplasia in Colorectal Polyp

ABSTRACT Objective: To determine the value of neutrophil-lymphocyte ratio for predicting high-grade dysplasia among patients with neoplastic colorectal polyp. Method: We evaluated 30 patients with non-neoplastic polyp, 61 patients with neoplastic polyp (32 with high-grade dysplasia/29 without high-grade dysplasia), and 30 patients with normal colonoscopy as control group. Mean platelet volume, red cell distribution width, neutrophil and lymphocyte levels were recorded and neutrophil-lymphocyte ratio was calculated. Results: Mean neutrophil-lymphocyte ratio of patients with neoplastic polyp were higher than patients with non-neoplastic polyp and control group (2.56 ± 1.47, 1.77 ± 0.44, 1.76 ± 0.62, retrospectively) (p = 0.001). Mean platelet volume of patients with neoplastic polyp (8.76 ± 1.06) was lower than patients with non- neoplastic polyp (9.50 ± 1.27) and control group (10.96 ± 0.83) (p < 0.001). Mean neutrophil-lymphocyte ratio of patients with high-grade dysplasia (3.03 ± 1.88) was significantly higher than patients without high-grade dysplasia (2.14 ± 0.77) (p = 0.022). The cut-off value of neutrophil-lymphocyte ratio to predict the presence of high-grade dysplasia was 2.044 (sensitivity: 69%, specificity: 68%). Conclusion: Neutrophil-lymphocyte ratio, which is a simple non-invasive index can predict high-grade dysplasia and neoplastic polyp. Although mean platelet volume and red cell distribution width are not useful for identifying high-grade dysplasia in patients with colorectal polyp, mean platelet volume may be associated with neoplastic polyp.

Risk factors for post-ERCP pancreatitis: it depends on the ERCP indication.

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication. PATIENTS AND METHODS: A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones. RESULTS: In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy. CONCLUSIONS: Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.

The relationship between severity of ulcerative colitis and thiol-disulphide homeostasis.

OBJECTIVES: The aim of the study was to determine dynamic thiol-disulphide homeostasis in patients with ulcerative colitis, compare it with those of healthy control and to investigate the relationship between the severity of the disease and homeostasisMETHODS: A total of 78 patients and 58 healthy subjects were included in the study. Serum native thiol, total thiol and disulphide amounts were measured by using a novel automated method. Obtained results were compared and relationships were determined by correlation analysis. RESULTS: Serum native thiol, total thiol, disulphide amounts and disulphide/native thiol percent ratio (index) were significantly lower (p = 0.003 for index ratio and p < 0.001 for other parameters) in patients with ulcerative colitis than in healthy controls. Native thiol, total thiol and disulphide amounts were significantly higher (p < 0.001) in patients with ulcerative colitis in remission than in patients with active ulcerative colitis and near to those of healthy control. There were significant negative correlations between the severity of the disease and thiol-disulphide homeostasis parameters (r = -0.55, p < 0.001 for native thiol; r = -0.64, p < 0.0001 for total thiol; r = -0.65, p < 0.001 for disulphide and r = -0.33, p = 0.011 for index). CONCLUSION: The thiol-disulphide homeostasis was weakened in ulcerative colitis. Strong correlations between the activity of the disease and thiol-disulfide homeostasis indicate that homeostasis may play a role in the pathogenesis of the disease (Tab. 3, Fig. 3, Ref. 30).

Effects of fucoidan on diabetic rat testicular tissue.

Increased reactive oxygen species (ROS) resulting from hyperglycemia and inadequate endogenous antioxidant systems are responsible for the complications of diabetes. ROS accumulate in the cell and stimulate apoptosis, which compromises sperm quality and function. We investigated the possible effects of fucoidan, a potent antioxidant with a regulatory effect on blood glucose homeostasis, on the testicular tissues of rats with experimental diabetes. Diabetes was induced by administering 40 mg/kg streptozotocin (STZ) on five consecutive days. Twenty-four Wistar albino male rats were divided into four groups: group 1, control group (CG); group 2, diabetes group (DG); group 3, early fucoidan group (EFG) treated with 50 mg/kg fucoidan after diabetes induction; group 4, late fucoidan group (LFG) treated with the same dose of fucoidan 15 days after diabetes induction. Fucoidan was administered intraperitoneally every two days for four weeks. Basement membrane thickness and Johnsen scores were higher in the DG than in the CG; no difference was found for either the EFG or LFG compared to the CG. Seminiferous tubule diameters of EFG were significantly greater than for the DG. Apoptotic tubule and apoptotic cell indexes were significantly greater in the DG and significantly less in the EFG and LFG groups compared to the CG. Early use of fucoidan in diabetic individuals may minimize damage to testicular tissue.

Association between serum vitamin D and parathyroid hormone levels in Turkish patients with colonic polyps.

UNLABELLED: Epidemiological and investigational studies have proved that vitamin D is important in autoimmune processes and has anticancerogenic properties. But the interplay between serum vitamin D and parathyroid hormone (PTH) in colorectal polyps has been less clearly put forward. We evaluated serum vitamin D, PTH levels in Turkish people and tried to stratify colorectal polyps according to risk factors. Patients undergoing colonoscopy between January 2012 and March 2012 were considered to study serum vitamin D levels during winter. Study population comprised of 98 colorectal polyp and 197 normal colonoscopy patients. RESULTS: Serum vitamin D levels were not different between the groups (mean vitamin D level in polyp group 14.3 ± 11.1 vs. 12.7 ± 6.74 the normal group, p = 0.12). Likewise serum PTH levels were not different between the groups Patients with polyps were further classified as high and low risk polyps. When discriminant function analysis was conducted, the effects of vitamin D or PTH levels were not again significant. During the study period 16 colorectal carcinoma cases were detected. Serum vitamin D or PTH levels were not significantly different between colorectal cancer or overall study group patients. Finally serum vitamin D levels were stratified into quartiles. Likewise there was not any significant difference between the groups. The present study suggests that serum vitamin D and PTH levels were not different between colorectal polyp and control groups. And serum vitamin D levels were significantly low in both groups suggesting a significant vitamin D deficient state in Turkish patients.

Unusual localization of a primary superficial venous aneurysm: a case report.

OBJECTIVES: Primary aneurysms of superficial venous system are rare and frequently misdiagnosed as varicose veins. Clinical presentation is variable depending on the presence of compression to surrounding structures. We report a rare case of primary cephalic vein aneurysm presented with wrist pain due to radial nerve compression. METHOD/CASE: A 61-year-old woman was admitted with right wrist pain and localized mass. Physical and imaging examinations showed a localized cephalic vein aneurysm compressing radial nerve. Simple excision was performed successfully. RESULTS: Cosmetic and clinical results at the first month follow-up were successful. DISCUSSION: Although primary superficial venous aneurysms of upper extremities are very rare, the treatment of choice is most commonly same as the ones in lower limbs. Simple excision is the best approach in the most of the cases, while sclerotherapy could be preferred in order to obtain better cosmesis or to avoid injuries to surrounding structures.

Comparison between Capsule Endoscopy and Magnetic Resonance Enterography for the Detection of Polyps of the Small Intestine in Patients with Familial Adenomatous Polyposis.

Objective. The objective of this study was to assess the utility of magnetic resonance enterography (MRE) compared with capsule endoscopy (CE) for the detection of small-bowel polyps in patients with familial adenomatous polyposis (FAP). Methods. Patients underwent MRE and CE. The polyps were classified according to size of polyp: <5 mm (small size), 5-10 mm (medium size), or >10 mm (large size). The location (jejunum or ileum) and the number of polyps (1-5, 6-20, >20) detected by CE were also assessed. MRE findings were compared with the results of CE. Results. Small-bowel polyps, were detected by CE in 4 of the 6 (66%) patients. Three patients had small-sized polyps and one patient had medium-sized polyps. CE detected polyps in four patients that, were not shown on MRE. Desmoid tumors were detected on anterior abdominal wall by MRE. Conclusion. In patients with FAP, CE can detect small-sized polyps in the small intestine not seen with MRE whereas MRE yields additional extraintestinal information.

Capsule endoscopy in celiac disease.

Capsule endoscopy (CE) has been increasingly used for diagnosing disease of the small bowel. It is an attractive technique for assessing celiac disease (CD) because it is noninvasive and provides a close and magnified view of the mucosa of the entire small bowel. The aim of this paper is to update the current data on the use of CE for diagnosing villous atrophy and complications of CD.

Cline: a new decision-tree family.

A new family of algorithm called Cline that provides a number of methods to construct and use multivariate decision trees is presented. We report experimental results for two types of data: synthetic data to visualize the behavior of the algorithms and publicly available eight data sets. The new methods have been tested against 23 other decision-tree construction algorithms based on benchmark data sets. Empirical results indicate that our approach achieves better classification accuracy compared to other algorithms.

Control of shivering during regional anaesthesia: prophylactic ketamine and granisetron.

BACKGROUND: The aim of the present study was to compare placebo, ketamine, granisetron and a combination of ketamine and granisetron in the prevention of shivering caused by regional anaesthesia. METHODS: In this prospective, randomized, double-blind study, 160 ASA I and II patients undergoing urological surgery were included. Subarachnoid anaesthesia was performed in all patients with bupivacaine 15 mg. The patients were randomly allocated to receive saline (group P, n= 40), ketamine 0.5 mg (group K, n= 40), granisetron 3 mg (group G, n= 40) or ketamine 0.25 mg + granisetron 1.5 mg (group KG, n= 40). Shivering was graded as 0 = no shivering, 1 = piloerection or peripheral vasoconstriction but no visible shivering, 2 = muscular activity in only one muscle group, 3 = muscular activity in more than one muscle group but not generalized, and 4 = shivering involving the whole body. If 15 min after spinal anaesthesia and concomitant administration of a prophylactic dose of one of the study drugs, the patients shivered according to at least grade 3, the prophylaxis was regarded as ineffective and intravenous (i.v.) pethidine 25 mg was administered. RESULTS: After 15 min, the number of patients with observed shivering was 22 in group P, 6 in group G, 7 in group GK and 0 in group K. The difference between group K and all the other groups was statistically significant (P < 0.0001). The number of patients with a shivering score of 3 was statistically significantly higher in group P compared with the other groups. CONCLUSION: The prophylactic use of 0.5 mg/kg i.v. ketamine was effective in preventing shivering developed during regional anaesthesia.

Extramedullary plasmacytoma of the maxillary sinus.

Extramedullary plasmacytomas (EMPs) are localized plasma cell neoplasms that occur within the soft tissues; by definition they cannot occur within bone. They account for 1-2% of all plasma cell growths and have a great predilection for the upper respiratory tract, without specific manifestations. Males are more frequently affected during the fifth and sixth decades of life. At initial presentation, multiple myeloma should be excluded. We report herein the case of a 63-year-old man with an EMP arising in the right maxillary sinus who was referred for surgical excision and postoperative radiotherapy and briefly review the clinical implications and management of this pathology.

Effects of S(+) ketamine added to bupivacaine for spinal anaesthesia for prostate surgery in elderly patients.

BACKGROUND AND OBJECTIVE: Intrathecal ketamine as the sole anaesthetic agent has demonstrated a lack of cardiovascular depression that should be of advantage in an elderly population. S(+) ketamine has three-times the analgesic potency of R(-) ketamine and its antinociceptive effects after intrathecal administration in rats are known. We decided to evaluate the effects of intrathecal S(+) ketamine added to a small dose of spinal bupivacaine in elderly patients undergoing transurethral prostate surgery. METHODS: Forty males over 60 yr old, scheduled for transurethral prostate resection under spinal anaesthesia, were studied in a prospective, double-blinded, randomized way. Patients were allocated to receive either bupivacaine 10 mg or bupivacaine 7.5 mg combined with S(+) ketamine 0.1 mg kg(-1). Spinal block onset time, maximum sensory level, duration of blockade, haemodynamic variables, postoperative analgesic requirements and adverse events were recorded. RESULTS: Onset times of motor and sensory block were shorter in the bupivacaine plus S(+) ketamine group. Incomplete motor block of the lower extremities was seen in 80% of the patients in bupivacaine plus S(+) ketamine group. Duration of complete motor block and spinal analgesia was shorter in the bupivacaine plus S(+) ketamine group. There was no significant difference in arterial pressure. Heart rate decreased after spinal anaesthesia in the bupivacaine plus S(+) ketamine group and was significantly lower until the end of anaesthesia. The incidence of adverse effects was not different between groups. CONCLUSIONS: Intrathecal S(+) ketamine administered with a low dose of bupivacaine provides shorter motor and sensory block onset time, shorter duration of action and less motor blockade in elderly males.

Comparison of additional metformin or NPH insulin to mealtime insulin lispro therapy with mealtime human insulin therapy in secondary OAD failure.

AIM: It has been found that non-fasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2 diabetes. The main aim of treatment of type 2 diabetic patients is to control plasma glucose and HbA1c levels. In this study, we aimed to assess the effects of three different insulin regimens (group I: lispro insulin + NPH insulin, group II: lispro insulin + metformin and group III: regular insulin + NPH insulin) on overall glycaemic control and metabolic parameters in type 2 diabetic patients with secondary oral anti-diabetic drug failure. METHODS: Sixty type 2 diabetic patients with secondary OAD failure were randomly allocated into three different treatment groups equally. There were no significant differences between groups concerning age, body mass index, diabetes duration, HbA1c and serum lipid levels at the beginning of the study. During the 6-month treatment period, blood glucose levels were determined 10 times during 24 h at pre-meal, post-prandial 1 and 2 h and at bedtime. RESULTS: Group I was found to be the most effective treatment regimen in controlling HbA1c levels (group I vs. group II, p = 0.013; group I vs. group III, p = 0.001; group II vs. group III, p > 0.05). When the comparison was made in each group, change in HbA1c was statistically significant for all groups (-3.18%, p = 0.001; -2.02%, p = 0.043 and -2.66%, p = 0.008 respectively). Group I was found to be more effective in controlling fasting and post-prandial plasma glucose levels measured at all times during the day when compared with group II and group III. In group II triglyceride levels were found to be significantly reduced, whereas other groups had no effect on lipids. No serious hypoglycaemic episodes were observed in any of the cases, whereas in group I hypoglycaemic episode rates were increased (chi2 = 8.843, p = 0.012). CONCLUSIONS: Lispro insulin plus NPH insulin regimen is more effective in controlling both pre- and post-prandial glucose levels and HbA1c when compared to regular insulin plus NPH insulin combination. Mealtime lispro insulin plus metformin combination therapy should also be seriously considered as an effective and alternative treatment regimen. It is worthy of attention that insulin lispro plus metformin lowered triglyceride levels.