Stress and psychopathology and its impact on quality of life in chronic anal fissure (CAF) patients.

BACKGROUND: Chronic anal fissure (CAF) onset, exacerbation, and impact on quality of life are influenced by a host of psychological, physiological, and social factors. We aimed to investigate the difference in psychopathology and stress between normal and CAF groups. METHODS: Thirty CAF patients and 20 age-sex matched healthy controls were evaluated for Axis I psychopathology, depression, anxiety, and stress with Hamilton and Hospital Depression-Anxiety Scales, Perceived Stress Scale, and SF-36. RESULTS: With a mean age of 39.47, 83.3% of CAF patients were female. Anxiety-depression and stress scores were all significantly higher and functionality was lower in the CAF group compared to controls (p < 0.001); 36.7% of the patients had a triggering stress factor and 56.6% had an exacerbating stress factor; 56.7% of the patients had an ongoing Axis I psychopathology while 50% had a previous psychopathology. Pain (96.7% had pain (VAS = 6.55)) and bleeding (83.3% had bleeding (VAS = 4.14)) severity showed a negative impact on bodily pain and role limitations emotional subscales of SF36. CONCLUSION: There is a high comorbidity of psychopathology in the CAF patients and depression and anxiety severities show a negative impact on the quality of life. Stress acts as both a triggering and an exacerbating factor in CAF.

Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study.

PURPOSE: Recent studies showed that sacral nerve stimulation might be an effective treatment option for chronic anal fissure. We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve. METHOD: In this prospective study, transcutaneous electrical nerve stimulation was applied for 10 days in addition to conventional medical treatment in ten patients. Wexner's constipation score, visual analog scale for pain, quality of life (Short Form-36), Hamilton anxiety and depression scores, symptom relief, compliance, fissure healing, and side effects were evaluated before and after treatment (days 0, 5, and 10). RESULTS: Ten patients (eight females/two males) with a mean age of 50.7 ± 18.5 years were enrolled in the study. Pain and bleeding resolved in all patients 2 days after the treatment, and mucosal healing was observed in six patients 10 days after the treatment. Wexner's constipation and visual analog scale scores for pain decreased significantly (p = 0.001 and p = 0.002, respectively). Hamilton anxiety and depression scores decreased as well (p = 0.001 and p = 0.01, respectively). Among Short Form-36 subscales, only mental health score increased significantly (p = 0.003). One patient underwent surgery at follow-up due to recurrence of symptoms, and rubber band ligation was applied to another patient who had internal hemorrhoidal rectal bleeding at the end of 10 days. CONCLUSIONS: Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.

A Chemically Induced Experimental Colitis Model with a Simple Combination of Acetic Acid and Trinitrobenzene Sulphonic Acid.

BACKGROUND: It was aimed to induce a new experimental colitis model by using acetic acid and trinitrobenzene sulphonic acid together and to investigate the severity of inflammation biochemically and histopathologically in comparison with other models. METHODS: Fifty-six Wistar albino male rats were randomly divided into 4 groups as control, acetic acid, trinitrobenzene sulphonic acid, and combined groups, and the animals were sacrificed following the induction of colitis on the third day and on the seventh day. The serum amyloid A and myeloperoxidase were tested in plasma samples, and the tumor necrosis factor-alpha, interleukin 33, and ST2 were assayed in colon tissue samples with enzyme-linked immunosorbent assay in addition to histopathological examination. RESULTS: There were statistically significant differences between the combined and the control groups both on the third day and on the seventh day in all parameters. There was no difference between the acetic acid group on the seventh day and the control groups in biochemical parameters. CONCLUSIONS: The acetic acid model forms acute colitis. The combined model is found to be more successful in forming inflammation when compared to other models.

Effects of Probiotic Bacteria on Central Neuronal Activation in Experimental Colitis.

BACKGROUND: Brain-gut axis dysregulation is observed in inflammatory bowel disease. However, the effect of altered gut flora on neuro- immunomodulation and its role in the pathogenesis of inflammatory bowel disease are unknown. The aims of this study are to determine (i) whether colitis modifies the expression of c-fos, a marker of general neuronal activation in the brain and (ii) whether this activation could be modulated by probiotic bacteria. METHODS: In this study, 28 Sprague-Dawley rats were divided into 4 groups: colitis-probiotic group, non-colitis-fed-control group receiv- ing probiotic Lactobacillus delbrueckii subsp. Bulgaricus B3 strain for 7 days, colitis group, and sham group receiving only sodium chlo- ride. Colitis was induced by intracolonic administration of trinitrobenzene sulfonic acid-ethanol. The expression of c-fos was detected by immunohistochemistry in the brain tissue. Cytokines and inflammatory mediators were analyzed in the plasma. Histological scores and oxidative status were analyzed in the colon samples. RESULTS: The inflammatory response was accompanied by increased levels of cytokines, lipid peroxidation activities, c-fos expression in the medial nucleus of the amygdala, and decreased levels of antioxidant enzymes in the colitis (P < .001). Probiotic treatment reversed those effects. Also, histopathologic scores were significantly lower in the probiotic-treated groups compared to the colitis group (P = .035). In contrast, the expression of c-fos was significantly increased in the paraventricular nucleus of hypothalamus in the probiotic- treated rats (P < .001). CONCLUSION: Colitis and intestinal inflammation are associated with the activation of neurons in the limbic system creating stress-like effects in the brain. Probiotics diversely modulate limbic response and hypothalamic axis activity in addition to protective effects in inflammation.

The effect of exopolysaccharide-producing probiotic strains on gut oxidative damage in experimental colitis.

BACKGROUND: Oxidative stress plays a role in disease initiation and progression in inflammatory bowel disease (IBD) and manipulation of this pathway may attenuate disease progress. In this study, the effect of exopolysaccharide (EPS)-producing probiotic bacteria on gut oxidative damage was evaluated in a rat model of experimental colitis. METHODS: Colitis was induced by intracolonic administration of acetic acid. Rats were treated daily with two probiotic strains, L. delbrueckii subsp. bulgaricus B3 strain (EPS of 211 mg/l; high-EPS group) or L. delbrueckii subsp. bulgaricus A13 strain (EPS of 27 mg/l; low-EPS group), which were given directly into the stomach. Non-colitis-fed control and preventative groups were only treated with the high-EPS producing strain. Antioxidant enzyme activities (superoxide dismutase, catalase, total glutathione, reduced glutathione, glutathione disulfide) and lipid peroxidation were measured in colonic tissue samples after a treatment period of 7 days. RESULTS: Significant oxidative damage was associated with a higher level of malondialdehyde (MDA) activity and reduced antioxidant enzyme activities in the colitis model group. All antioxidant enzyme activities were higher in both probiotic-treated groups compared with those of the colitis model group (P < 0.001). Lipid peroxidation was significantly ameliorated in both probiotic groups. The improvement of oxidative stress parameters was significantly more in the high-EPS group than in the low-EPS group (P < 0.001). CONCLUSIONS: EPS-producing probiotic bacteria significantly attenuate oxidative stress in experimental colitis. Increased EPS production gives rise to a better probiotic function. These results suggest that EPS molecules could revaluate probiotic strains and exert their beneficial effects on the host and this may have a therapeutic potential.

Perineal leiomyoma mimicking complex Bartholin mass.

Leiomyomas of the external genitalia are uncommon soft tissue tumors. We report the case of a 47-year-old woman with perineal leiomyomas mimicking Bartholin's gland mass according to the preoperative magnetic resonance imaging (MRI) findings. Leiomyomas in the vulvar region should be differentiated from complicated Bartholin's gland cysts and preoperative MRI findings may be misleading. The complete surgical excision should be the choice of treatment.

Erythema nodosum associated with granulomatous mastitis: report of two cases.

Granulomatous mastitis is a rare breast disease characterized by chronic inflammation. Clinical presentation of granulomatous mastitis usually mimics malignancy or infection. Coincidence of granulomatous mastitis and erythema nodosum is a quite rare feature. In this paper, we aimed to present two young women with granulomatous mastitis accompanied by erythema nodosum and successfully treated with corticosteroids. Granulomatous mastitis should be kept in the mind for differential diagnosis of erythema nodosum.

Effects of probiotics on radiation-induced intestinal injury in rats.

OBJECTIVE: Radiotherapy is an important aspect of multimodal cancer therapy, but radiation-induced acute intestinal injury is a common and serious problem. Disruption of morphologic mucosal integrity and normal bacterial microflora after abdominal radiation leads to malabsorption and bacterial translocation. METHODS: Lactobacillus bulgaricus strain isolated from yogurt was given as a probiotic to rats subjected to radiotherapy. On postradiation day 8 rats were killed. Mesenteric lymph nodes, liver, and spleen were excised for microbiologic examinations. Segments of jejunum, ileum, and colon were evaluated for the presence of inflammation, vascularity, and mucus cells. RESULTS: The results of this study suggest that probiotics may have a protective effect on intestinal mucosa. CONCLUSION: Probiotics added as substrates can be given by an oral or enteral route to patients who undergo radiotherapy to prevent radiation-induced enteritis and related malnutrition.

Importance of cyst content in hydatid liver surgery.

HYPOTHESIS: Cyst content in hydatid liver surgery is a determinant of postoperative cavity-related complications. DESIGN: Cohort analytic study. SETTING: Referral public hospital. PATIENTS: Sixty-seven patients who had conservative surgery for hydatid liver disease were analyzed prospectively. Cysts were grouped as to the contents. Cysts containing bile and/or pus were considered complicated, whereas others were uncomplicated. After partial cystectomy, cavities were managed with external drainage, omentopexy, or introflexion, determined by the choice of the surgeons. MAIN OUTCOME MEASURES: Outcomes were measured by postoperative cavity-related complications, such as biliary leakage (leakage for 10 days or less), biliary fistula (leakage for more than 10 days), cavity infections, and postoperative hospitalization. RESULTS: Patient and cyst characteristics were comparable among the groups. External drainage technique had slightly more frequent cavity-related complications than omentopexy or introflexion (1.5-fold to 2-fold difference). More importantly, complications were significantly more frequent in the complicated cysts than in the uncomplicated cysts (7-fold to 30-fold difference). Mean postoperative hospitalization time for uncomplicated cysts was 6.5 days, and it was similar whether they were treated by external drainage, omentopexy, or introflexion (7.0, 6.2, and 5.8 days, respectively). Mean postoperative hospitalization time for complicated cysts was longer than for uncomplicated cysts (17.5 days; P =.008). CONCLUSIONS: Uncomplicated cysts have lower complication rates and short hospital stay with each cavity management technique. Complicated cysts have higher complication rates and longer hospital stay regardless of the management technique. Therefore, complicated and uncomplicated cysts should be considered different forms of the disease and evaluated differently.

Global fibrinolytic capacity in colorectal cancer: a new clue to occult fibrinolysis.

Hemostatic disorders in cancer patients range from asymptomatic laboratory changes to massive thromboembolism or hemorrhage. Routine laboratory tests often fail to identify patients at high risk for hemostatic complications. The postoperative risk of thromboembolic events in colorectal cancer was reported as approximately 2% to 5%. A new diagnostic test was used to assess global fibrinolytic activity, which may detect occult fibrinolysis or disseminated intravascular coagulation in patients with colorectal cancer. Twenty patients with colorectal cancer and 20 healthy control subjects were involved. Using standard silicated fibrin pellets and tissue plasminogen activator, the fibrinolytic capacity of the plasma samples was detected with the amount of D-dimer produced before the reaction was stopped by adding aprotinin to the medium. Mean global fibrinolytic capacity was increased in patients before and after surgery when compared to controls (p = 0.002, p = 0.001, respectively). In conclusion, a hemostatic imbalance was detected toward primary fibrinolysis in the preoperative period and low-grade disseminated intravascular coagulation postoperatively.

The effects of splenectomy and splenic autotransplantation on plasma lipid levels.

PURPOSE: Atherosclerosis observations after splenectomy for trauma and hypersplenism suggests a possible role for the spleen in lipid metabolism. The authors examined the effects of splenectomy on serum lipids in rats and also cholesterol-fed rats with experimental atherosclerosis. METHODS: This study was designed on rats. The rats were divided into five groups: splenectomy, normal diet (SP-N, n: 8), splenectomy, cholesterol-fed groups (SP-C, n: 8), splenic autotransplantation after splenectomy, normal diet (SA-N, n: 8), splenic autotransplantation after splenectomy, cholesterol-fed groups (SA-C, n: 8) and sham groups (n: 8). Total triglyceride, total cholesterol, HDL (high-density lipoprotein), LDL (low-density lipoprotein), and VLDL (very low-density lipoprotein) levels were determined in 40 rats. The rats were classified into five groups based on the surgical procedures. The spleens were removed and then the rats were fed a normal diet in Group SP-N (n = 8). The spleens were removed and then the rats were fed a diet containing 1% cholesterol in Group SP-C (n = 8). Splenectomy and splenic autotransplantations were performed and then the rats were fed a normal diet in Group SA-N (n = 8). Splenectomy and splenic autotransplantations were performed and then the rats were fed a diet containing 1% cholesterol in Group SA-C (n = 8). The rats were sham-operated in the control group (Group S, n = 8). An active splenic function was shown in rats that underwent splenic autotransplantation in both groups by using Technicium 99 m sulphurcolloide sintiscan on day 30. Blood lipid levels were repeated 6 months later. RESULTS: There was no difference between pre- and postoperative lipid levels in the sham group and SA-N group (p >.05). All lipid levels including HDL were increased significantly in SP-C group (p <.05). Also VLDL and total tryglyceride levels were increased significantly in SP-N and SA-C groups (p <.05). CONCLUSIONS: This study showed that the spleen might have an important effect on lipid metabolism and splenic autotransplantation may be protective in conditions with increased lipid levels.

Effects of exopolysaccharide-producing probiotic strains on experimental colitis in rats.

PURPOSE: Inflammatory bowel disease is suggested to result from a dysregulated immune response toward intestinal microflora, which may be restored by probiotic therapy based on the concept of healthy microflora. Ideal probiotic bacteria may be beneficial in inflammatory bowel disease; however, the mechanism of action and the clinical efficacy of probiotic usage are still unclear. In the present study, the effect of exopolysaccharide producing probiotics was evaluated on an experimental colitis model in rats. METHODS: Colitis was induced by intracolonic administration of acetic acid. Then, rats were treated daily with two probiotic strains, Lactobacillus delbrueckii subsp. bulgaricus B3 strain (exopolysaccharide of 211 mg/l: high-EPS group) or Lactobacillus delbrueckii subsp. bulgaricus A13 strain (EPS of 27 mg/l: low-EPS group), which were given into the stomach. The non-colitis-fed control group was only treated with high-exopolysaccharide strain. The model-control and control groups were treated only with tap water. Rats were killed after a seven-day treatment period. Disease activity was quantified by use of histologic scores and colonic myeloperoxidase activity, which is a marker of neutrophil infiltration during inflammation. RESULTS: The enhanced inflammatory response was accompanied by a higher level of myeloperoxidase activity in the colitis group. Histologic scores of colonic damage and myeloperoxidase activity were lower in both probiotic-treated groups compared with those of the colitis control group (P<0.001), although the mentioned scores improved significantly more in the high-EPS group than in the low-EPS group (P<0.001). CONCLUSIONS: Exopolysaccharide-producing probiotics significantly attenuate experimental colitis, which may be mediated by exopolysaccharide in a dose-dependent manner. Therefore, exopolysaccharide-producing probiotics may be a promising therapeutic role in inflammatory bowel disease.

Serum homocysteine level in Behçet's disease.

Recent studies of the prevalence of hyperhomocysteinemia in Behçet's disease have shown contradicting results. The aim of the present study was to investigate the serum homocysteine level in patients diagnosed as having Behçet's disease. Venous blood was taken from 27 patients with Behçet's disease and 21 healthy controls. Serum homocysteine levels were measured using fluorescence polarization immunoassay. In addition, serum vitamin B12 and folic acid levels were measured by chemiluminescent enzyme immunoassay. The mean levels of vitamin B12, folic acid, and homocysteine were not significantly different in patients with Behçet's disease when compared with the healthy controls (p = 0.17, p = 0.13, and p = 0.05, respectively). The results of this study confirmed that homocysteine levels were not elevated in Behçet's disease when compared with the control group. Further studies in a subset of Behçet patients with a history of thrombosis are needed to determine the prevalence of hyperhomocysteinemia in the thrombotic form of the disease.