The protective effect of L-carnitine on hepatic ischemia-reperfusion injury in rats.

BACKGROUND/AIMS: Ischemia-reperfusion injury may occur during liver transplantation and remains a serious concern in clinical practice. This study was designed to study the potential benefit of L-carnitine on experimental warm hepatic ischemia-reperfusion injury in rats. MATERIALS AND METHODS: Forty-five male Wistar Albino rats were divided into three groups; Group 1 sham-operation without ischemia-reperfusion (n=15); Group 2, ischemia-reperfusion (n=15); and Group 3, which was administered L-carnitine (200 mg/kg, intraperitoneal, for 4 days) prior to ischemia-reperfusion (n=15). The study animals were then sacrificed to obtain hepatic tissue and serum samples. Tissue levels of malondialdehyde and reduced glutathione and serum levels for aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase were assessed. RESULTS: Mean aspartate aminotransferase levels were significantly higher in Group 2 (405.2 U/L) when compared to Groups 1 (137.1 U/L) and 3 (267.6 U/L). Mean alanine aminotransferase levels were significantly higher in Group 2 (257.1 U/L) when compared to Groups 1 (37.2 U/L), and 3 (118.1 U/L) (p< 0.001 for each). Mean lactate dehydrogenase levels were significantly higher in Group 2 (2943.8 U/L) when compared to Groups 1 (1496.5 U/L), and 3 (2185.3U/L) (p < 0.001 for each). Mean malondialdehyde levels were significantly higher in Group 2 (54.3 nmol/g) compared to Groups 1 (41.0 nmol/g) and 3 (42.1 nmol/g) (p < 0.001 for each). Mean reduced glutathione levels were significantly lower in Group 2 (5.9 nmol/mg) and Group 3 (7.4 nmol/mg) compared to Group 1 (9.1 nmol/mg) (p < 0.001 for each). CONCLUSIONS: In conclusion, our data supports a protective effect of L-carnitine against oxidative damage in hepatic ischemia-reperfusion injury in rats. This is evidenced by improvement of the antioxidant defense system and lipid peroxidation levels.

Efficacy and safety of sodium phosphate for colon cleansing in type 2 diabetes mellitus.

OBJECTIVES: The need for colonoscopy is common among diabetic patients. However, there are no standards per se for bowel preparation in patients with type 2 diabetes. In this study, we evaluated the efficacy, safety, and tolerability of sodium phosphate (NaP), and the quality of bowel cleansing in relation to glycemic control and late complications. METHODS: A total of 50 consecutive type 2 diabetic patients and 50 non-diabetic patients underwent bowel preparation by NaP. Fasting blood glucose, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium, and creatinine levels were measured on the procedure day. Patients were given a tolerability questionnaire regarding symptoms. RESULTS: With regard to bowel preparation quality, optimal bowel cleansing was achieved in 35 (70%) diabetic and 47 (94%) non-diabetic patients (P = 0.002). Abdominal pain or discomfort during and an hour after the procedure was similar in both groups (P >0.05). The changes in Na, K, Ca, P and creatinine levels after NaP use did not reach statistical significance between the groups (P >0.05). In the diabetic patients, there was a significant correlation between the quality of bowel cleansing and mean age, duration of diabetes mellitus, level of hemoglobin A1c (HbA1c), fasting blood glucose level, and diabetic late complications (P <0.05). CONCLUSION: These data suggest that NaP is safe and tolerable in diabetic patients, but the quality of bowel cleansing is worse than in non-diabetic patients. These observations support the concept that the quality of bowel cleansing in those with type 2 diabetes is closely related to the duration and regulation of the disease and the presence of late complications.

The effect of autonomous neuropathy on bowel preparation in type 2 diabetes mellitus.

INTRODUCTION: The need for colonoscopy is common among diabetics. In this study, we aimed to evaluate the effect of autonomous neuropathy on bowel preparation in type 2 diabetes mellitus (DM) patients. MATERIALS AND METHODS: The study population consisted of 45 patients with DM and 48 non-diabetic, age- and sex-matched subjects. All colonoscopies were performed 5 h after the last dose of sodium phosphate. Colonoscopists rated the bowel preparation quality during the procedure using the Aronchick scale. All patients underwent a detailed cardiologic examination and 24-h Holter rhythm monitoring. Orthostatic hypotension and impairment in heart rate variability were accepted as indicators of autonomous neuropathy. RESULTS: Gender, age, blood pressure, and heart rates did not differ significantly between groups (p > 0.05). Autonomous neuropathy was detected in 14 (31.1%) patients in the DM group and in two (4.2%) in the control group (p < 0.05). Optimal bowel cleansing was achieved in 93.8% of controls and 73.3% of diabetics; bowel cleansing was suboptimal in 26.7% of diabetics and 6.2% of controls (p < 0.05). Optimal bowel cleansing was achieved in six of 14 (42.8%) diabetic patients with autonomous neuropathy; however, optimal bowel cleansing was achieved in 27 of 31 (87.1%) diabetic patients without autonomous neuropathy (p < 0.05). Although optimal bowel cleansing was more prevalent among control patients than in diabetic patients without autonomous neuropathy, the difference was not significant (87.1% vs 93.8%; p > 0.05). CONCLUSION: These data suggest that optimal bowel cleansing is poorer in diabetics with autonomous neuropathy than in those without autonomous neuropathy and controls.

Total colonic polyp diameter: a marker for the risk of malignancy?

BACKGROUND/AIMS: The correlation of the risk of malignancy with the sum of the diameters of small colonic polyps is unknown, and data regarding this topic are lacking. In this study, the relationship between the sum of the diameters of the total number of colonic polyps and poor histopathologic characteristics was examined. METHODS: A total of 920 neoplastic colon polyps were evaluated in 480 patients. The "total polyp diameter" (i.e. the sum of all polyp diameters identified during colonoscopy), which was calculated in each patient by adding the diameter of each polyp to a sum, was categorized as "small" (<10mm in diameter) or "large" (> or =10mm in diameter). The polyps were further categorized by histopathologic component as "unfavorable" or "favorable" and were divided into 2 groups: group 1 (those identified as carci noma, carcinoma in situ, villous adenoma, and tubulovillous adenoma with a villous component of more than 25%) and group 2 (mixed adenomatous polyps with various degrees of hyperplastic or inflammatory components and adenomas with a tubular component of more than 75%). RESULTS: Large polyps that had a total diameter greater than or equal to 10mm tended to have poor histopathologic characteristics (p<0.05). Polyps generally tended to localize in the left portion of the colon, and malignant polyps or those at risk for malignancy in particular tended to localize in the left colon (p<0.05). CONCLUSIONS: Polypectomy is recommended for patients in whom the sum of the diameter of all colonic polyps exceeds 10mm.

Evaluation of the Turkish translation of the Minimal Standard Terminology for Digestive Endoscopy by development of an endoscopic information system.

BACKGROUND/AIMS: There are very few evaluation studies for the Minimal Standard Terminology for Digestive Endoscopy. This study aims to evaluate the usage of the Turkish translation of Minimal Standard Terminology by developing an endoscopic information system. METHODS: After elicitation of requirements, database modeling and software development were performed. Minimal Standard Terminology driven forms were designed for rapid data entry. The endoscopic report was rapidly created by applying basic Turkish syntax and grammar rules. Entering free text and also editing of final report were possible. After three years of live usage, data analysis was performed and results were evaluated. RESULTS: The system has been used for reporting of all endoscopic examinations. 15,638 valid records were analyzed, including 11,381 esophagogastroduodenoscopies, 2,616 colonoscopies, 1,079 rectoscopies and 562 endoscopic retrograde cholangiopancreatographies. In accordance with other previous validation studies, the overall usage of Minimal Standard Terminology terms was very high: 85% for examination characteristics, 94% for endoscopic findings and 94% for endoscopic diagnoses. Some new terms, attributes and allowed values were also added for better clinical coverage. CONCLUSIONS: Minimal Standard Terminology has been shown to cover a high proportion of routine endoscopy reports. Good user acceptance proves that both the terms and structure of Minimal Standard Terminology were consistent with usual clinical thinking. However, future work on Minimal Standard Terminology is mandatory for better coverage of endoscopic retrograde cholangiopancreatographies examinations. Technically new software development methodologies have to be sought for lowering cost of development and the maintenance phase. They should also address integration and interoperability of disparate information systems.

Thrombopoietin or interleukin-6 has no effect on thrombocytopenia of cirrhosis.

BACKGROUND/AIMS: We aimed to compare the level of thrombocytopenia in cirrhotic patients with HBV and those with HCV, and to investigate whether the reduced serum level of IL-6 in patients with HCV is responsible for the lower platelet count compared to those with HBV through the effect on serum thrombopoietin level. METHODOLOGY: Fifty-three patients with liver cirrhosis, 28 of who were HBV- seropositive (Group A), 25 of who were HCV- seropositive (Group B) and 15 healthy controls were enrolled in this study. RESULTS: Platelet count in group B [75 (1.5-99) K/microL] were lower than those of group A [140 (62-374) K/microL] (p < 0.001). The median levels of serum thrombopoietin in patients [group A: 31.9 (31-113) pg/mL and group B: 38.0 (31.2-102) pg/mL] and controls [31.3 (31-153) pg/mL] did not show statistically significant difference. The patients compared to controls, had higher serum IL-6 levels [3.6 (2-1150) vs. 2.0 (2-9.9) pg/mL], (p < 0.01), which showed similarity in group A and B patients [3.65 (2-1150) vs. 3.3 (2-45) pg/mL], (p=NS). Serum thrombopoietin level was not correlated with serum IL-6 levels in any group. Serum thrombopoietin and IL-6 levels had no relationship with platelet count and with Child-Pugh score. CONCLUSIONS: Our study showed that cirrhotic patients with HCV had lower platelet count than those with HBV and controls, and this difference does not appear to be related with either serum thrombopoietin or IL-6 level.

Pegylated interferon Alfa-2b monotherapy and pegylated interferon Alfa-2b plus lamivudine combination therapy for patients with hepatitis B virus E antigen-negative chronic hepatitis B.

Forty-eight hepatitis B virus (HBV) E antigen-negative chronic hepatitis B patients received pegylated interferon alfa-2b either alone or with lamivudine for 48 weeks and were followed for an additional 24 weeks. At the end of follow-up, virological response rates (HBV DNA levels of <400 copies/ml) were similar in the monotherapy (24%) and combination therapy (26%) groups.

Factors prognostic of survival in patients awaiting liver transplantation for end-stage liver disease.

In this study, we investigated possible independent predictive factors for survival, other than MELD score, in patients with cirrhosis. We reviewed the serum sodium, cholesterol, albumin, and platelet levels of 99 patients with cirrhosis and investigated the possible correlation of these parameters with survival period. We found that 77% and 81% of patients with cirrhosis were hypocholesterolemic and hypoalbuminemic, respectively. We noted that the survival time of 6 months in patients with serum sodium levels <125 mM at the time of admission to the study was 27% less than that in patients with sodium levels >130 mM. Patients with cirrhosis and serum sodium levels >130 mM survived for more than 1 year (95% CI). MELD scores of patients with serum sodium levels >130, between 125 and 129, and <125 mM were 15.8 to 19.9, 19.7 to 23.6, and 23.3 to 27.2, respectively (95% CI). In conclusion, we suggest that although all of these parameters are correlated with survival in patients with cirrhosis, the serum sodium level is the most accurate prognostic factor and a valid tool for predicting survival when considered in combination with the MELD score.

Malignancy risk of small polyps and related factors.

The aim of this study was to determine the risk of polyps <6 and between 6 and 10 mm in terms of progression to malignancy and to evaluate the influence of age, gender, and colonic localization on malignancy development. Thirteen hundred sixty-nine polyps <10 mm identified in 680 patients were retrospectively evaluated. Sixty-seven and two-tenths percent of polyps <10 mm were of a neoplastic nature. The incidence of neoplasia was higher in left-sided and small polyps than diminutive polyps. In patients older than 60 years, small polyps showed a higher rate of high-risk histology than diminutive polyps,while the same relationship did not exist in other age groups. In male patients over 60 years of age, the rate of high-risk histology was higher in small polyps than in diminutive polyps.

Effect of supportive extracorporeal treatment in liver transplantation recipients and advanced liver failure patients.

Recently, continuous venovenous hemodiafiltration (CVVHDF) and plasmapheresis (PF) were suggested as supportive therapy options in combination with standard treatment in advanced liver failure. The aim of this study was to analyze the effects of supportive extracorporeal treatment (SET) in a group of patients with advanced hepatic failure. A total of 25 patients (7 women, 18 men; mean age, 39.3+/-15.4 years; 13 were transplant recipients [6 women, 7 men; mean age, 37.7+/-16.9 years]) were included. All patients were in hepatic coma and receiving standard coma and liver failure management when they received SET. Number of SET sessions; levels of serum blood urea nitrogen, creatinine, albumin, calcium, phosphorus, ammonia, alanine and aspartate aminotransferase, and total/conjugated bilirubin; and prothrombin times (PTT) before and after SET were recorded retrospectively. 7.7+/-7.9 SET sessions were performed. Thirteen liver transplant recipients required SET for an average of 9.7+/-8.3 days after transplantation. Serum ammonia and bilirubin levels were lower after termination of supportive therapy when compared with initial levels (p<0.0001 and p<0.005 respectively). During follow-up, hepatic encephalopathy and liver failure resolved in 11 patients, while 14 patients (7 transplant recipients) died. There was no significant difference between patients in either group except that PTT was shorter in patients who survived (p<0.01). Further analyses revealed that in surviving patients, ammonia clearance was higher (p<0.01). In patients with advanced liver failure, or liver transplants, CVVHDF and/or PF could be supportive options combined with standard treatment.

Is hepatitis C virus positivity a contributing factor to occult hepatitis B virus infection in hemodialysis patients?

Hepatitis B (HBV) infections continue to occur in adult hemodialysis units. Occult HBV infection (serum hepatitis B surface antigen [HBsAg] negative but HBV DNA positive) may be a contributing factor in these patients. This study was designed to (1) investigate the prevalence of occult HBV infection in hemodialysis patients and (2) compare the prevalence of occult HBV infection among hepatitis C (HCV)-positive and HCV-negative hemodialysis patients. The study included 138 patients on chronic hemodialysis. Eighty-four patients were HCV positive and 54 were HCV negative. HBV DNA testing was performed by polymerase chain reaction. We also recorded general characteristics of the patients, duration of hemodialysis, and serum alanine aminotransferase and aspartate aminotransferase levels. Twenty-one (15.2%) of the 138 hemodialysis patients were HBV DNA positive. Nine (16.6%) of the 54 anti-HCV antibody negative hemodialysis patients were HBV DNA positive. Twelve (14.2%) of the 84 anti-HCV antibody positive patients were HBV DNA positive. The prevalence in anti-HCV Ab positive and negative hemodialysis patients were same (P > .05). Hemodialysis duration, demographic features, and biochemical parameters were not significantly different in patients with and without occult HBV infection in both HCV-positive and -negative hemodialysis patients (P > .05). HCV positivity is not a contributing factor to occult HBV infection in hemodialysis patients. None of the parameters tested help to distinguish patients with occult HBV infection from those who are HBV DNA negative.

Involvement of the esophagus in a patient with pemphigus vulgaris who was on immunosuppressive therapy.

Esophageal involvement of pemphigus vulgaris (PV) had been considered an exceptional event. We present the case of a woman with PV who developed esophageal involvement while being treated with azathioprine and resolved after steroid therapy. This case highlights that esophageal involvement of PV might be resistant to immunosuppressive therapy other than steroids.

Ultrasonographic evaluation of gallbladder functions in patients with irritable bowel syndrome.

BACKGROUND: The aim of the present study was to evaluate gallbladder function in irritable bowel syndrome (IBS) patients. METHODS: The functions of gallbladder were investigated every 30 min for 4 h. In addition, ejection fraction of the gallbladder was calculated from the fasting and post-prandial volumes. RESULTS: In IBS patients and healthy controls, fasting gallbladder volumes were 19.64 +/- 3.09 mL and 20.04 +/- 1.82 mL, and residual volumes after 3 h were 3.36 +/- 6.82 mL and 9.74 +/- 1.50 mL. Except for the residual volume after 3 h, all these results were not statistically significant. Residual volume after 3 h was statistically significantly lower in the IBS patients than in the controls (P < 0.001). Ejection fraction of the gallbladder was significantly higher in the IBS patients than in the controls (84% vs 55%, P < 0.001). CONCLUSIONS: Gallbladder contraction in patients with IBS was not different from that of a control group at post-prandial second hour but was signigicantly more pronounced at the end of 3 h when compared with controls. Ejection fraction of the gallbladder was higher in IBS patients when compared with controls.

Distribution of HCV genotypes in patients with end-stage renal disease according to type of dialysis treatment.

The objective of this study was to investigate the effects of types of dialysis treatments on hepatitis C virus infection and the epidemiologic properties of hepatitis C virus (HCV) infection at three Baskent University hospitals, in Ankara, Adana, and Izmir, Turkey, in 655, 326, and 118 patients with end-stage renal disease, respectively. One hundred thirty patients with HCV viremia among 271 patients with end-stage renal disease seropositive for HCV were included in this cross-sectional study. HCV RNA-positive patients were classified according to the renal replacement therapies (hemodialysis or continuous ambulatory peritoneal dialysis), and viral load, transaminase levels, and distribution of genotypes were compared between these subgroups. In the continuous ambulatory peritoneal dialysis group, 26 of 165 patients (16%) were serum anti-HCV positive, and 11 of 26 patients (42%) were serum HCV RNA positive. Twenty-six percent of the patients undergoing hemodialysis were anti-HCV positive, and 49% were HCV RNA positive. The prevalence of genotype 1b was 68% and 73% for patients in the continuous ambulatory peritoneal dialysis and hemodialysis groups, respectively. No significant differences were found between the genotype 1b and the non-1b groups or between different dialysis types with regard to age and sex and serum aspartate transaminase, alanine aminotransferase, and HCV RNA levels. We conclude that HCV seropositivity may differ between different types of dialysis treatments, although viral load and genotypes may be similar in persons with end-stage renal disease and those without.

Route of nutrition has no effect on the development of infectious complications.

BACKGROUND: Infection is a serious complication of nutritional support, causing a high rate of mortality and morbidity. Critically ill patients having nutritional support are prone to infectious complications. Questions regarding the effects of the route of nutrition in infectious complications have been asked. We aimed to determine the relationship between the route of nutrition and the risk of developing infectious complications in severely ill patients on nutritional support in an intensive care unit. METHODS: A retrospective review was performed on the files of 144 severely ill patients who had either enteral or parenteral nutrition during follow-up in an intensive care unit. The primary diagnoses of patients were heterogenous. RESULTS: Sixty-eight (35.8%) of them acquired novel infections during the hospitalization period. Forty-nine and 19 of the 68 infected patients had enteral and parenteral nutrition support, respectively. Seventy-six (40%) of the patients were free of infection. Fifty-one of 76 infection-free patients had enteral nutrition support, and 25 of them had parenteral nutrition support. Pulmonary infections, urinary tract infections, catheter infections and septicemia were the most frequent types of infectious complications. There was no significant difference in the rate of infectious complications between enteral nutrition and parenteral nutrition groups (p > 0.05). CONCLUSION: We conclude that the route of the nutritional support in severely ill patients having nutritional support in an intensive care unit does not affect the rate of infectious complications. We think that comorbid medical conditions and the need of intensive care unit support are more important parameters that determine the risk of development of infectious complications.

Helicobacter pylori seroprevalence in patients with coronary artery disease.

Recent studies have suggested that chronic infections such as Helicobacter pylori may be a risk factor for coronary artery disease (CAD). The aim of thIS study was to investigate the seroprevalence of H. pylori in patients with CAD. We enrolled 151 patients with CAD (93 men and 58 women, aged 48.1 +/- 17.3 years [mean +/- SD]) and 149 control subjects matched by age and sex (90 men and 59 women, aged 51.4 +/- 13.9 years). An enzyme-linked immunosorbent assay immunoglobulin (Ig) G test for H. pylori diagnosis was performed on all enrolled subjects (CAD patients and controls). Ninety-one of 151 patients with CAD (60.2%) and 86 of the 149 subjects in the control group (57.7%) were H. pylori positive (P > 0.05). H. pylori infection rates were similar in patients with CAD and control groups. The main conclusion of this study is that H. pylori infection is not a risk factor for developing CAD. Further studies should be undertaken to confirm our results.

Helicobacter pylori seroprevalence in patients with chronic bronchitis.

AIM: A high rate of seropositivity for antibodies against Helicobacter pylori has been found in many extra-gastrointestinal diseases. In addition, it has been reported that the risk of chronic bronchitis may be increased in subjects infected with H. pylori. This study was designed to determine the H. pylori seroprevalence in patients with and without chronic bronchitis. MATERIALS AND METHODS: This study enrolled 68 patients with chronic bronchitis (40 men and 28 women, aged 50.5+/-16.2 years (mean+/-standard deviation) and 95 control subjects (60 men and 35 women, aged 51.8+/-15.9 years) matched for age and sex. An enzyme-linked immunosorbent assay immunoglobulin (Ig) G test for H. pylori diagnosis was performed on all enrolled subjects (those with chronic bronchitis and controls). RESULTS: Forty-five of 68 patients with chronic bronchitis (66.1%) and 48 of 95 subjects in the control group (57.7%) tested positive for H. pylori (P=0.008). Rates of H. pylori infection are higher in patients with chronic bronchitis than in the control group. CONCLUSION: The main conclusion of this study is that H. pylori infection is associated with an increased prevalence chronic bronchitis. Further studies should be planned to understand the potential pathogenetic mechanisms that might underlie this association.

The relationship of ABO blood group, age, gender, smoking, and Helicobacter pylori infection.

It is well known that blood group antigens are related to the development of peptic ulcer and gastric carcinoma. This study sought to determine the relationship between H. pylori and ABO/Rhesus blood groups, age, gender, and smoking. Patients (335 women and 205 men; mean age, 51.68 +/- 15.0 years; range, 18-85 years) who attended our outpatient clinic were enrolled in the study. All patients were randomly selected in each age group. Demographic data recorded for each patient included age, gender, and tobacco use. Blood samples were tested for H. pylori antibodies, and ABO/Rhesus blood group antigen typing was performed. Serum antibodies were tested against H. pylori infection. Prevalences of all blood groups were O (29.2%), A (38.2%), B (17.8%), and AB (14.8%). As expected from previous studies, we found that seropositivity for H. pylori increased with age. H. pylori Ig G antibody positivity was detected in 185 of 335 women (60.6%), compared with 88 of 205 men (42.9%), a statistically significant difference (P < 0.05). H. pylori Ig G antibody positivity was detected in 206 of 379 nonsmokers (54.3%) compared with 67 of 161 smokers (41.6%), a statistically significant difference (P < 0.05). Patients in blood groups A and O were more prone to H. pylori infection than were patients in other blood groups (P < 0.05), and patients in the AB blood group were less prone to H. pylori infection compared with patients in other blood groups (P < 0.05). The results of this study demonstrate that H. pylori infection can be related to ABO blood group, age, gender, and smoking.