Role of baseline adenoma characteristics for adenoma recurrencein patients with high-risk adenoma

Background/aim: The present observational study aimed to determine the predictive value of 3-year recurrence adenoma characteristics at baseline conventional colonoscopy in patients with high-risk adenoma.Materials and methods: A total of 47 patients with high-risk adenoma at baseline colonoscopy were followed up and underwent a surveillance colonoscopy at 3 years. Correlations between adenoma recurrence and baseline adenoma characteristics (size, number, histological features, and location) were analyzed.Results: Among 135 patients with high-risk adenoma, 47 patients (35%) who underwent surveillance colonoscopy at 3 years following baseline colonoscopy were included in the study. In these 47 patients, at least one new adenoma was detected in 19 (40.4%) patients, and new advanced adenomas were detected in 5 (10.6%) patients during the surveillance colonoscopy. No significant difference was found in patients who had adenoma recurrence versus those who did not in terms of size of adenomas (P = 0.143), number of adenomas (P = 0.562), histological properties of adenomas (P = 0.658), or locations of adenomas (P = 0.567).Conclusion: Baseline adenoma characteristics were not associated with the recurrence of adenomas or advanced adenomas in patients with high-risk adenoma.

Chronic liver diseases and iron: a concise review with emphasis on hypotransferrinemia and hypohepcidinemia.

Iron studies in chronic liver diseases (CLDs) have a long history. Currently we can mention certainties, uncertainties, and hopes related to this topic. It is certain that iron metabolism problems and hepatic siderosis are frequent in CLDs and they get more frequent as CLD progresses, but true iron overload is rare. There are conflicting literature data on the mechanism of siderosis, the role of iron in CLD pathogenesis, and the potential benefits of iron removal. We may hope that pharmacological approaches targeting iron metabolism disorders of CLD will be actively evaluated in the future. In this review, we aimed to present a general outlook of this extensively studied topic.

Analysis of Non-Small Bowel Lesions Detected by Capsule Endoscopy in Patients with Potential Small Bowel Bleeding.

Gastrointestinal (GI) bleeding cases in whom source cannot be identified after conventional upper and lower GI endoscopy are defined as potential small bowel bleeding. We aimed to search for lesions in the reach of conventional endoscopy in patients to whom video capsule endoscopy (VCE) had been applied for potential small bowel bleeding. 114 patients who had VCE evaluation for potential small bowel bleeding between January 2009 and August 2015 were retrospectively evaluated. Mean age of the patients was 55 ± 17 years. Female/male ratio is 39/75. In 58 patients (50.9%) bleeding lesion could be determined. Among these 58 patients 8 patients' lesions were in the reach of conventional endoscopes. Overall these 8 patients comprised 7% of patients in whom VCE was performed for potential small bowel bleeding. Among these 8 patients 5 had colonic lesions (4 angiodysplasia, 1 ulcerated polypoid cecal lesion), 2 had gastric lesions (1 GAVE, 1 anastomotic bleeding), and 1 patient had a bleeding lesion in the duodenal bulbus. Although capsule endoscopy is usually performed for potential small bowel bleeding gastroenterologists should always keep in mind that these patients may be suffering from bleeding from non-small bowel segments and should carefully review images captured from non-small bowel areas.

Increased mean platelet volume is related to histologic severity of primary biliary cirrhosis.

AIM: To evaluate the main platelet volume (MPV) as a severity marker in patients with primary biliary cirrhosis (PBC). MATERIALS AND METHODS: Thirty-nine patients with biopsy-proven and as yet untreated PBC followed between January 2008 and January 2015 were included in this study. Liver biopsies were categorized as early stage (stage 1 and 2 according to Scheuer's histological stage) and late stage (Scheuer's stage 3 and 4). As part of the routine evaluation, all PBC patients had their full blood count and biochemistry profile determined, where MPV, white blood cell count, hemoglobin, platelet count, red cell distribution width (RDW), alanine aminotransferase, aspartate aminotransferase (AST), gamma glutamyl transferase, alkaline phosphatase, and total bilirubin values were evaluated. Both groups were compared in terms of the RDW/platelet ratio, the AST platelet ratio index, and the neutrophil lymphocyte ratio. RESULTS: Eighteen patients had early-stage disease (46.2%), whereas 21 PBC patients had late-stage disease (53.8%). There were no differences between groups in terms of routine hematological parameters (white blood cell count, platelet count, hemoglobin, RDW) or biochemical parameters (alanine aminotransferase, AST, gamma glutamyl transferase, alkaline phosphatase, total bilirubin, albumin) (P>0.05). Similarly, there were no differences in AST platelet ratio index, RDW/platelet ratio, or neutrophil lymphocyte ratio values between groups (P values 0.08, 0.19, and 0.14, respectively). The MPV and direct bilirubin were significantly higher in the advanced stage group compared with the early-stage group (11.08 vs. 9.73 fl, respectively, P=0.01 and 0.44 vs. 0.28 mg/dl, respectively, P=0.03). The area under the curve, cut-off value, sensitivity, and specificity of MPV and direct bilirubin for detecting advanced stage were 0.721, 10.3, 71%, and 66%, respectively, and 0.698, 0.23, 71%, and 66%, respectively. CONCLUSION: MPV can be used as a noninvasive, simple, and effective parameter in patients with PBC to predict histological severity of the disease.

An Unusual Reason for Gastric Variceal Hemorrhage: Wandering Spleen.

Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22-year-old woman with wandering spleen presenting with life-threatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.

Evaluation of gastric polyps detected by endoscopy: a single-center study of a four-year experience in Turkey.

BACKGROUND/AIMS: The aim of this study was to evaluate the gastric polyps detected by endoscopy in our institution with respect to their frequency, size, anatomic location, presence of dysplasia, and histopathologic features. MATERIALS AND METHODS: Records of a total of 14,240 patients who underwent endoscopy between January 2008 and January 2012 were reviewed retrospectively. Of the 14,240 patients, 174 determined to have at least 1 histopathologically proven polyp were included in the study. RESULTS: Three hundred eleven gastric polyps were found in 174/14,240 (1.2%) patients (1.79 polyps per patient). Gastric polyps were found most commonly in the antrum (41.5%). Of all gastric polyps, 189 (60.8%) were less than 1 cm. Histopathologically, the most common polyp type was hyperplastic (n: 261, 83.9%), followed by adenomatous (n: 23, 7.4%). Eight (34.8%) of the adenomatous polyps showed dysplasia, and in 4 (17.4%) of these cases, the dysplasia was high-grade. Nineteen (6.1%) of all gastric polyps were identified to be fundic gland polyps. CONCLUSION: According to this study from Turkey, the majority of polyps detected by endoscopy was solitary, smaller than 1 cm, and found in the antrum; furthermore, the most common type was a hyperplastic polyp.

Acute pancreatitis caused by bortezomib.

Drug-induced pancreatitis has been reported rarely. Bortezomib is a selective and reversible proteasome inhibitor used for the treatment of patients with multiple myeloma (MM). Recently, one case report about acute pancreatitis (AP) caused by bortezomib was published in the international literature. Herein we report a case of AP in a 67-year-old male on bortezomib therapy. On the fourth day after the first administration of bortezomib, the patient admitted to the hospital with symptoms of AP. The common etiological factors for AP were all excluded. Than the patient was diagnosed as bortezomib-induced pancreatitis.

Anticoagulant-induced intramural duodenal haematoma presenting with upper-gastrointestinal haemorrhage.

Warfarin is an anticoagulant agent known to have a common complication, bleeding. Intramural intestinal haematoma is an uncommon incidence of warfarin-induced haemorrhage. Abdominal pain is its most frequent symptom and presentation with upper-gastrointestinal haemorrhage is rarely seen. Here, we present a 67-year-old male who was admitted to the hospital with active upper-gastrointestinal haemorrhage. In this case, the cause of bleeding has been attributed to duodenal intramural haematoma due to warfarin overuse.

Serum iron parameters in cirrhosis and chronic hepatitis: detailed description.

BACKGROUND/AIMS: Serum iron parameters are affected by liver disorders. It is believed that the tests are unreliable in chronic liver disease, and systemic iron overload should be evaluated histologically in these patients. However, the effect of severity of chronic liver disease on serum iron parameters has not been evaluated. Similarly, differences between liver disease- and iron overload related iron parameter changes have not been clarified. We aimed to describe the effect of severity of chronic liver disease on serum iron tests and to elucidate the differences of liver disease- and iron overload-related iron parameter changes. METHODS: Commonly used serum iron parameters were studied in patients with cirrhosis, chronic viral hepatitis and in persons with confirmed hemochromatosis. Cirrhosis cases were categorized according to Child-Pugh classification. RESULTS: We found that cirrhotic persons of any Child-Pugh class had deviations from normal results. Patients with chronic hepatitis had normal serum iron parameters. Total iron binding capacity decreased as liver disease progressed from hepatitis toward Class C cirrhosis (r= -0.53, p<0.001). Changes in ferritin and transferrin saturation were essentially opposite to this trend (r=0.3, p=0.01 and r=0.47, p<0.001, respectively). Serum iron level was lower in cirrhosis compared to hepatitis. Increased transferrin saturation and ferritin levels resembling iron overload were limited to Class C cirrhotics. Patients with true iron overload could be easily differentiated from these cases by hyperferremia. CONCLUSION: Aberrant serum iron test results indicate cirrhotic stage in chronic liver disease. Cirrhosis and systemic iron overload cause characteristically different changes in serum iron parameters.

Effect of platelet count on secretion capacity: formulization and use of the formulae for evaluation of platelet secretion in thrombocytopenic patients.

The correlation between platelet count and bleeding time is nonlinear. The bleeding time prolongs more prominently as platelet count decreases toward 10 000 microl(-1); however, it becomes stable near 100 000 microl(-1). Clinical observations suggest that platelet functional capacity may also play a role in bleeding complications during thrombocytopenia. However, no routine method has been described for evaluation of platelet function during thrombocytopenia. To test if platelet functional capacity is affected by the cell count, as suggested by the platelet count-bleeding time correlation. To evaluate lumiaggregometry as a possible tool for studying platelet functions and prediction of bleeding in thrombocytopenic patients. Collagen-induced ATP release was studied in different dilutions of 22 healthy platelet-rich plasmas. The relationship between platelet count and ATP release was formulized. ATP release was also tested in 24 thrombocytopenic (10 000-50 000 microl(-1). ) patients, and the results were compared with expected levels derived from the formulae. ATP release increased in a cubic fashion as platelet count elevated. ATP secretion values were within normal limits or increased in patients with idiopathic thrombocytopenic purpura. However, some patients with megakaryocyte deficiency had a secretion defect. ATP secretion was decreased in four out of seven patients with bleeding symptoms compared with no persons without bleeding (P = 0.003). Platelet functional capacity is affected by the cell count. Lumiaggregometry is potentially useful in evaluating platelet functions during thrombocytopenia.

Evidence for higher red blood cell mass in persons with unconjugated hyperbilirubinemia and Gilbert's syndrome.

BACKGROUND: The genetic polymorphism responsible from Gilbert's syndrome is not sufficient for the clinical phenotype to occur in many persons. Additional factors are believed to contribute in pathogenesis. Red cell mass may be such a factor. METHODS: We have retrospectively evaluated computer records of all liver function tests assayed between January 2005 and February 2006. The database was screened to find cases with unconjugated hyperbilirubinemia and normal liver enzymes and blood count values on simultaneous assays. The control group for comparison of surrogate markers of total red cell mass comprised of age- and gender-matched persons who had laboratory tests with completely normal results on the same day with the hyperbilirubinemic cases. Gilbert's syndrome cases were found with medical record assessment, and these cases and their control subjects were more strictly assessed. Three different control groups were established for Gilbert's syndrome cases, one of them including healthy blood donors and personnel. RESULTS: In 48,516 otherwise normal laboratory test results, we have found that 491 male subjects and 323 female subjects with unconjugated hyperbilirubinemia had higher hemoglobin, hematocrit, and red blood cell values compared with age- and gender-matched control subjects (P < 0.001 for all comparisons). Twenty-six males who had been followed for Gilbert's syndrome also showed higher hemoglobin, hematocrit and red cell count values in comparison to all control groups. Mean red cell volume value did not differ between the hyperbilirubinemic persons and control groups. CONCLUSIONS: Relatively increased red cell mass probably plays a role in the pathogenesis of Gilbert's syndrome.

A pericardial hydatid cyst masquerading as acute inferolateral myocardial infarction--a case report.

A case of pericardial hydatid cyst adjacent to the inferoposterial wall of the left ventricle is reported. Significant ST segment elevations in leads D2, D3, aVF, V5, and V6 on surface electrocardiography and sudden onset of severe chest pain mimicked acute inferolateral myocardial infarction. However, cardiac catheterization and coronary angiography showed normal coronary arteries and normal left ventricular cavity. The ST segment elevation in the inferolateral leads disappeared a few days after surgical resection of the cyst. Cardiac hydatid cyst should be considered in the differential diagnosis of patients with angina-like chest pain in endemic areas.

Predictors of left ventricular thrombus formation in patients with dilated cardiomyopathy: role of activated protein C resistance.

OBJECTIVES: The aim of this study was to investigate the association between left ventricular thrombus formation and natural anticoagulant systems including the protein C, protein S and antithrombin in patients with dilated cardiomyopathy. MATERIALS AND METHODS: Sixty patients with dilated cardiomyopathy who met the inclusion criteria were included in the study. Patients were divided into two groups: group I consisted of 22 patients with left ventricular thrombus and group II consisted of 38 patients without left ventricular thrombus. Our main inclusion criteria were ejection fraction /= 6.0 cm. These two groups were compared for clinical and hematologic parameters (activated protein C resistance, protein S and antithrombin). RESULTS: There were no statistically significant differences between patients with or without left ventricular thrombi with respect to left ventricular end-diastolic and end-systolic dimensions, ejection fraction, fractional shortening and left atrial diameter. There were no statistically significant differences between patients with and without left ventricular thrombus with respect to platelet count (252 +/- 64/mm3 x 10(3) compared with 260 +/- 74/mm3 x 10(3) respectively, P=0.68), prothrombin time (12.94 +/- 1.9 s compared with 12.86 +/- 1.3 s respectively, P=0.82), activated partial thromboplastin time (32 +/- 5 compared with 30 +/- 4 s respectively, P=0.32) and fibrinogen levels (36 +/- 9 mg/dl compared with 34 +/- 8 mg/dl respectively, P=0.41). None of the patients had protein S and antithrombin deficiency. Activated protein C resistance was found in 12 patients (12 out of 22, 54%) in group I and four patients (four out of 38, 9.5%) in group II (P < 0.01). It was also shown to be an independent predictor of left ventricular thrombus (P < 0.05). CONCLUSION: Activated protein C resistance is found to be an independent predictor of left ventricular thrombus in patients with dilated cardiomyopathy who have ejection fractions less then 35% and left ventricular end-diastolic dimensions > 6.0 cm.