Does an acute increase of intraabdominal pressure effect esophageal sphincter pressure?

BACKGROUND/AIMS: The study was designed to observe the acute alterations between lower esophageal sphincter (LES) and intraabdominal pressure (IAP) in patients undergoing diagnostic laparoscopy. METHODOLOGY: Eleven patients (7 Male), aged 49 fitting the criteria for manometric research and diagnostic laparoscopy were studied. To measure the IAP in sterile conditions a new device (IAP measurement system) was set. Pressures at basal (b), during intraabdominal CO2 insufflations (min, m2, m3) and at the end of laparoscopy (me), were recorded simultaneously. All results were given as the difference between two maneuvers (A). Paired sample t-test was used. RESULTS: The results were as follows; at the time of maximum CO2 insufflations: p delta m1-b; 24.25 vs. 14.64 mmHg, during the stabile insufflations: p delta m2-m1; -2.88 vs. 2.99 mmHg, p delta m3-m2; -0.70 vs. -0.82 mmHg and after deflation of CO2; end of the laparoscopy; p delta m(e)-m3; -16.73 vs. -16.65 mmHg for LESP and IAP respectively. The response of the LESP and IAP were similar in all phases (p > 0.05). Also alterations of pressures according to gender or presence of cirrhosis were found to be similar. CONCLUSIONS: LESP is changed synchronously in the presence of acute pressure changes in IAP. Gender or presence of cirrhosis does not affect the response of LES.

Liver biopsy: is the pain for real or is it only the fear of it?

Although percutaneous liver biopsy (PLB) has very low mortality and morbidity rates, it often is considered painful and frightening by the patients. This study was designed to grade the intensity of pain expected before the procedure and experienced during the procedure, and whether there is any correlation between pain and the emotional state of the patient. A total of 118 consecutive patients (aged 19-68 (mean, 44) years), who were undergoing PLB for the first time, were included in the study. Visual Analogue Scale (VAS) was used before the procedure, after the procedure to grade the degree of pain expected, and the degree of the pain experienced respectively. All the patients were evaluated by a questionnaire for their personality and emotional situation by using the Minnesota Multiphasic Personality Inventory Somatization Sub-scale (MMPI-SS). Mean VAS score for expected pain before the procedure was 60+/-20 and for the pain experienced during the procedure was 22+/-16 (P < 0.0001). Although the expected pain scores of female patients were significantly higher than males (66+/-22 vs. 55+/-17; P=0.003), there was no difference between female and male patients in the experienced pain scores. The procedure of PLB is expected to be more painful than it really is by the patients, especially by females. Calming the patients by informing them about the procedure and their diseases will probably diminish the expected pain.

p21 and p27 immunoexpression in gastric well differentiated endocrine tumors (ECL-cell carcinoids).

AIM: To investigate the expression of cyclin-dependent kinase inhibitors p21 and p27 in gastric well differentiated endocrine tumors (GWDET) (ECL-cell carcinoids). METHODS: The expressions of p21 and p27 were examined immunhistochemically in endoscopic biopsy specimens from 16 patients matching the diagnostic criteria of GWDET. Percentage of positive nuclear staining either weak or strong was noted. The association of immunoexpressions with age, gender, tumor localization, multifocality and accompanying chronic atrophic gastritis, neuroendocrine cell hyperplasia (NEH), neuroendocrine dysplasia (NED), intestinal metaplasia (IM), Ki-67 proliferation index and clinical outcome were also evaluated. RESULTS: All cases expressed p27 with a mean expression score of 43.6%, while 31.3% of the cases showed any p21 expression. p21 and p27 immunoexpressions were significantly correlated with each other (P < 0.01), and the p21-expressing group had higher p27 expression scores (68% vs 22%). p21 and p27 expressions were lower in women, in non-atrophic mucosa and cases whose tumors were located somewhere other than fundus without submucosal extension. On contrary, p21 and p27 expressions were higher in males and the patients with submucosal extension and atrophic gastritis. Cases presenting lower p27 scores had solitary tumors showing neither NEH-NED nor IM. Despite, cases with lower p21 expression presented multifocal tumors accompanied by NEH-NED. However, no correlation of p21 and p27 expressions was found with age and Ki-67 expression. CONCLUSION: p27 is widely expressed in GWDETs, while p21 expression is sparse and observed in two thirds of the cases. Loss of p21 and p27 expressions may be correlated with different carcinoid tumor subtypes; however, more studies are needed to assess the role of these prospective markers in gastrointestinal endocrine tumors.

Esophageal tuberculosis mimicking esophageal carcinoma.

Esophageal tuberculosis is rare. In some cases, the clinical presentation of this infection may mimic esophageal carcinoma. Differential diagnosis may be difficult and may result in an unnecessary surgical therapy such as esophagectomy. In this report we document the endoscopical, radiological, histological and bacteriological features of esophageal tuberculosis in a 62-year-old woman. She was admitted to our hospital complaining of dysphagia and odynophagia. Upper gastrointestinal endoscopy revealed an ulcerovegetant lesion in the right wall of the esophagus suggesting esophageal carcinoma. Further investigation resulted in a diagnosis of esophageal tuberculosis. She was successfully treated by antituberculous chemotherapy. We suggest that esophageal tuberculosis has to be kept in mind in the differential diagnosis of esophageal ulcerovegetant lesions.

Severe exudative ascites as an initial presentation of Crohn's disease.

Ascites in the course of Crohn's diseases is rarely seen and usually is a result of a concomitant malignancy, infection or thrombosis of portal or hepatic veins. In this article, a 55-year-old female patient suffering from severe ascites and finally diagnosed as Crohn's disease is presented. Further investigations revealed no malignancy, peritoneal infection or vein thrombosis. Treatment of Crohn's disease with steroids and 5-aminosalicylic acid also resulted in the disappearance of the ascites.

The efficacy of two-week therapy with ranitidine bismuth citrate, amoxicillin and clarithromycin on Helicobacter pylori eradication in clarithromycinresistant and- sensitive cases.

BACKGROUND/AIMS: Recent studies in Turkey have documented the noticeably low success rates of H. pylori eradication. It has become more important to identify the highly successful therapy regimens since clarithromycin resistance, one of the most important factors affecting the success rate of eradication therapies, continues to increase. The aim of this study was to assess the efficacy of two-week therapy with ranitidine bismuth citrate (RBC), amoxicillin (A), and clarithromycin (C) on H. pylori eradication, and the role of C resistance in eradication. METHODS: The study included 45 dyspeptic patients with H. pylori diagnosed by urease test and histopathological examination. C resistance was studied by real-time PCR method on antral biopsy specimens. All patients were treated with a two-week therapy consisting of RBC: 2x400 mg, A: 2x1000 mg, and C: 2x500 mg, daily. Endoscopy was repeated at least one month after the end of the treatment. Presence of H. pylori was investigated by urease test and histopathological examination on antrum and corpus biopsies. Eradication was considered when both tests were negative for H. pylori in all specimens. RESULTS: Two cases were lost to follow-up. The average age of the remaining 43 patients (22 males, 21 females) was 46.3+/-11.5 years. Mild side effects were encountered in 20 (46.5%) patients. Eradication was achieved in 35 (81.4%) patients. C resistance was studied in 26 patients and was detected in 10 (38.5%) of them. H. pylori eradication rate was 81.3% in C-sensitive (13/16) and 80% in C-resistant patients (8/10) (p>0.05). CONCLUSION: A two-week regimen of RBC-A-C is very effective for H. pylori eradication even in C-resistant patients. These results suggest that RBC-A-C combination should be preferred for H. pylori eradication in Turkey.

Leukotriene receptor antagonism in experimental acute pancreatitis in rats.

OBJECTIVES: Acute pancreatitis is a multifactorial disease caused by activation of several inflammatory mediators. Leukotrienes, beside other mediators, may be involved in acute pancreatitis. The aim of this study was to investigate the effects of 'zafirlukast', a leukotriene receptor antagonist, in acute pancreatitis and its relation with prostaglandin synthesis. METHODS: Eighty rats were randomly divided into eight groups. Acute pancreatitis was induced by subcutaneous injection of cerulein (20 microg/kg), four times at 1-h intervals. Zafirlukast (20 mg/kg) was applied intraperitoneally as a pretreatment. Prostaglandin synthesis was inhibited by low-dose indomethacin (5 mg/kg subcutaneously). Pancreatic histopathology, serum amylase activity and pancreatic myeloperoxidase activity were determined to assess the severity of pancreatitis. RESULTS: Zafirlukast pretreatment alone did not induce any inflammation and fatty necrosis in pancreatic tissue. However, it increased the histopathological score from 3.70 +/- 0.57 to 6.62 +/- 0.53 in rats with acute pancreatitis (P < 0.001). Fatty necrosis was especially prominent in the zafirlukast-treated acute pancreatitis group compared with the untreated group (2.62 +/- 0.26 versus 0.40 +/- 0.22, respectively; P < 0.001). Inhibition of prostaglandin synthesis by indomethacin partially suppressed the harmful effects of zafirlukast in acute pancreatitis. It decreased the pathological score (4.62 +/- 0.73) and fatty necrosis (1.50 +/- 0.32) in that group. CONCLUSION: Interestingly, leukotriene receptor antagonism by zafirlukast increased the pancreatic histopathological score and fatty necrosis in rats with acute pancreatitis. Blocking of cysteinyl leukotriene receptors might cause an induction of mediator synthesis via other pathways. Effects of leukotriene receptor antagonism on the pancreas must be evaluated extensively in further studies.