An unusual cause of anaemia: Rapunzel syndrome, a case report.

Trichobezoars present with stomach ache and with a mass in the stomach. It's common in the young and middle-aged women having psychiatric disorder, presenting with stomach ache and existence of mass in the stomach. Although it's one of the rare causes of anaemia it should be considered when dealing with cases of chronic and unresponsive anaemia.

The importance of antioxidant status in gastric intestinal metaplasia.

BACKGROUND: Oxidative stress status in different cancer types was investigated before, but not studied in gastric intestinal metaplasia to the best of our knowledge. Purpose of this study is to examine whether there is a difference between oxidative stress status in patients with intestinal metaplasia (IM) compared to individuals without IM, we compared the serum levels of disulfide (SS), total thiol (TT) and native thiol (NT). METHODS: This was a prospective, non-randomized casecontrol study including 67 patients with histopathologically confirmed IM and 60 individuals demographically matched in terms of age, gender, BMI, smoking status, and chronic diseases as control group. RESULTS: The mean NT, TT and NT to TT (NT/TT) ratios were statistically significantly higher in IM group compared to controls ((351.71 ± 81.9 mol/L vs. 271.82 ± 54.13 mol/L, p=0.000), (391.5 ± 92.69 mol/L vs. 308.59 ± 55.53 mol/L, p=0.000) and (0.89 ± 0.6 vs. 0.87 ± 0.29, p=0.022), respectively). The mean SS to TT (SS/TT) ratio was significantly lower in IM group than control group (0.050 ± 0.31 vs. 0.060 ± 0.014, P=0.022). Median SS and mean SS/NT ratio was similar in both groups (16.3 (3.3-78) vs. 18.3 (10-32.7), p=0.271 and 0.055 ± 0.041 vs. 0.070 ± 0.019, p=0.068, respectively). In ROC analysis, cut off value of SS/NT for IM was found 0.062, in regression analysis, SS/NT <0.062 was found as an independently prognostic marker for IM (OR, 2.38; 95%CI: 1.168-4.865, P=0.017). CONCLUSIONS: SS/NT ratio lower than 0.062 was found as an independently prognostic marker for IM. This ratio could help to distinguish which patients should be followed closely for gastric cancer.

A bioactive product lipoxin A4 attenuates liver fibrosis in an experimental model by regulating immune response and modulating the expression of regeneration genes.

BACKGROUND/AIMS: Lipoxin A4 (LXA4), an anti-inflammatory lipid mediator, regulates leukocyte cellular activity and activates gene transcription. The therapeutic effect of LXA4 on liver fibrosis and its mechanism on the immune system are largely unknown. Because the regenerative capacity of hepatocytes in acute and chronic liver failure models of mouse increases by silencing MKK4, we aimed to investigate the effect of parenteral administration of LXA4 on the genes responsible for regeneration of liver, namely MKK4, MKK7, and ATF2, and visualize the therapeutic effects in an experimental model. MATERIALS AND METHODS: Fibrosis was induced in mice by administration of thioacetamide (TAA). LXA4 was administered during the last two weeks of fibrosis induction. The fibrosis level was measured by Knodell scoring. The liver function was measured by analyzing serum ALT, AST, and AP levels. Expression levels of genes responsible for liver fibrosis (TGF-α) and cell regeneration (MKK4, MKK7, and ATF2) have been measured by RT-PCR analysis. Inflammatory and anti-inflammatory cytokine levels were measured in serum samples and liver homogenates by Enzyme Linked Immunosorbent Assay (ELISA). Ultrathin sections were examined using a transmission electron microscope and analyzed. RESULTS: We observed significant healing in liver of the LXA4-treated group, histologically. This finding was in parallel with reduction of serum ALT, AST, but not AP levels. TGF-α and MKK4 expressions were significantly reduced in the LXA4-treated group. Administration of LXA4 caused significant elevation of IL-10 in systemic circulation; however, that elevation was not detected in liver homogenates. Nevertheless, significant reductions in TNF-α and IL-17 have been observed. CONCLUSION: The anti-inflammatory effect of LXA4 maintains the regenerative capacity of liver during fibrosis in an experimental liver fibrosis model. LXA4 may be therapeutically beneficial in liver fibrosis.

Dose-dependent effects of kefir on colitis induced by trinitrobenzene sulfonic acid in rats.

Evidence suggests that gut microbiota dysbiosis plays a critical role in the initiation and promotion of inflammatory bowel disease (IBD). Kefir is a fermented dairy product including yeast and bacterial species. We aimed to investigate the effect of kefir on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats using two different doses. Fifty-four Wistar rats were divided into six groups. For 14 days, the normal control and colitis control groups were given tap water, kefir10 control, kefir10 colitis, and kefir30 control, and the kefir30 colitis groups were given phosphate-buffered saline containing 10% or 30% kefir, respectively, instead of tap water. Colitis was induced by intracolonically administrating TNBS in the colitis control, kefir10 colitis, and kefir30 colitis groups. On the 14th day, the rats were sacrificed. The weights and lengths of the colons were measured and macroscopically evaluated, and the distal 10 cm segments were subjected to a histopathological examination. The incidence of bloody stool and diarrhea in the kefir10 colitis group was found to be less than the colitis control and kefir30 colitis groups. The colonic weight/length ratio in the kefir10 colitis group was lower than that in the colitis control and kefir30 colitis groups. We detected that the 10% kefir treatment reduced TNBS-induced macroscopic colonic damage, while it was exacerbated by the 30% kefir treatment. No significant difference was observed between the colitis groups in terms of microscopic colonic damage scoring. These results indicate that kefir, with a careful dose selection, may be a useful agent in the treatment of IBD.

Ulcerative colitis presenting as leukocytoclastic vasculitis of skin.

A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD), including pyoderma gangrenosum, erythema nodosum, perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.

Can 5-aminosalicylic acid suppository decrease the pain after rectal band ligation?

AIM: To investigate the effect of 5-aminosalicylic acid (5-ASA) suppositories on rectal band ligation-induced pain. METHODS: Sixty patients were randomized into two treatment groups. RESULTS: Our results showed that there was no difference between 5-ASA suppository group and the control group for pain control. CONCLUSION: 5-ASA may be an alternative treatment for hemorrhoids; however, it does not affect the rectal band ligation-induced pain.

Linagliptin-related pancreatitis in a diabetic patient with biliary calculus: A case report.

RATIONALE: Dipeptidyl peptidase-4 inhibitors are commonly used drugs for the treatment of type 2 diabetes mellitus. While acute pancreatitis cases induced by saxagliptin, sitagliptin, and vildagliptin (all of which are members of the dipeptidyl peptidase-4 group) have been reported, there is no clear evidence suggesting that linagliptin may cause pancreatitis, and information in this regard is limited to a few studies. Moreover, no pancreatitis cases have been reported that were directly associated with linagliptin. PATIENT CONCERNS: We present a case of linagliptin-related pancreatitis in a 79-year-old male diabetic patient with biliary calculi. The patient, who was diagnosed with acute pancreatitis 4 months after initiating linagliptin 5 mg/d treatment, was admitted to our hospital. DIAGNOSES: The patient's pancreatic enzymes were high. Ultrasonography showed multiple biliary calculi, and abdominal computed tomography showed edematous pancreatitis. INTERVENTIONS: Linagliptin was discontinued and clinical improvement was achieved with standard acute pancreatitis treatment. OUTCOMES: This is the 1st case report suggesting that linagliptin might be associated with the risk of pancreatitis and could be an etiologic cause of pancreatitis, similar to the other members of its group. LESSONS: While the results of previous studies stated that there was no data to prove a causal relationship between dipeptidyl peptidase-4 inhibitors and pancreatitis, concerns regarding this subject have continued to arise. Therefore, new and comprehensive studies are needed to determine the long-term effects of dipeptidyl peptidase-4 inhibitors on type 2 diabetes mellitus patients and to shed light on the side effects of these medications.

Suttonella indologenes peritonitis in a patient receiving continuous ambulatory peritoneal dialysis.

Suttonella indologenes is a Gram-negative, aerobic coccobacillus of Cardiobacteriaceae family and its natural habitat is the mucous membranes of the upper respiratory system. The literature includes limited number of case reports concerning fatal endocarditis due to infection in the prosthetic heart valves caused by the aforementioned microorganism. However, there is no information on extracardiac involvement due to this microorganism. Here, we present a peritonitis case caused by Suttonella indologenes in a patient receiving continuous ambulatory peritoneal dialysis.

An unusual location of squamous cell carcinoma and a rare cutaneous infection caused by serratia marcescens on the tumoral tissue: A case report.

RATIONALE: Serratia marcescens (S. marcescens) is an opportunistic pathogen of the Enterobacteriaceae family. Although S. marcescens is known to cause sepsis, meningitis, endocarditis, urinary system and ocular infections, skin infections are sporadic. Squamous cell carcinoma (SCC) is the most aggressive skin cancer type that is often located in the head and neck region, and rarely in the scalp tissue. PATIENT CONCERNS: An 89-years-old male patient was diagnosed with SCC three years ago. The frontal region of the skull showed an ulcerated tumor, irregular borders, and exophytic growth pattern. The destruction of the frontal bone made the vibrating brain tissue visible, and the lower part had haemopurulent flow. DIAGNOSES: Gram staining showed the proliferation of gram (-) bacilli. Bacteria were identified as non-pigmented S. marcessens in the wound culture. To the best of our knowledge, there have not been any cases reported with S. marcescens causing cutaneous infections on SCC. Therefore, our report is the first case in the literature. INTERVENTIONS: According to the culture antibiogram, S. marcescens was ciprofloxacin sensitive. Consequently, 1000 mg/day ciprofloxacin was initiated for 14 days. OUTCOMES: Purulent exudate in skin cancers may be caused by the nature of carcinoma tissue as well as the colonization of opportunistic pathogen microorganisms as seen in our patient. LESSONS: Examination of the wound cultures and elimination of infections are critical in these cases.

Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension.

AIM: To investigate whether mean platelet volume (MPV) is a predictor of variceal bleeding in patients with cirrhotic portal hypertension. MATERIALS AND METHODS: This prospective cohort was performed in the internal medicine department of our tertiary care center. Cirrhotic patients were allocated into two groups: Group I consisted of 31 cases without a history of variceal bleeding, whereas group II was made up of 31 patients with a history of variceal bleeding. Data derived from medical history, physical examination, ultrasonography, gastrointestinal system endoscopy, complete blood count, hepatic, and renal function tests were recorded and compared between two groups. On physical examination, encephalopathy and ascites were evaluated and graded with respect to Child-Pugh-Turcotte classification. RESULTS: There was no significant difference between the two groups in terms of age, duration of the disease, and gender of the patient. The only remarkable difference was that hemoglobin (p = 0.02) and hematocrit (p = 0.02) values were lower in group II. Neither the etiology of bleeding was different between groups nor did MPV seem to have a noteworthy impact on bleeding. Interestingly, risk of variceal bleeding increased in parallel to the higher grade of varices. CONCLUSION: Our results imply that there is a correlation between the grade of varices and esophageal vari-ceal bleeding in cirrhotic patients. However, association between MPV and variceal bleeding could not be demonstrated. Utilization of noninvasive tests as predictors in these patients necessitates further controlled trials on larger series.How to cite this article: Erdogan MA, Benli AR, Acmali SB, Koroglu M, Atayan Y, Danalioglu A, Kayhan B. Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension. Euroasian J Hepato-Gastroenterol 2017;7(1):6-10.

Investigation of Helicobacter pylori in the middle ear of the patients with chronic otitis media by CLO test and 14C urea breath test.

OBJECTIVE: The aim of this study was to investigate the presence of Helicobacter pylori by CLO test in the middle ear of the patients with chronic otitis media. We also investigated the relationship between H. pylori in the stomach and in the middle ear by 14C urea breath test (14C UBT) for the possible source of this bacterium. STUDY DESIGN: A prospective controlled clinical study. METHODS: Tissue samples were obtained from the middle ear mucosa of 41 patients undergoing ear surgery for chronic suppurative otitis media and placed in the CLO test kit. C UBT was performed in 24 patients and 20 normal subjects. RESULTS: The CLO test results were positive in 22 patients (53.6%). Results of 14C UBT that was performed in 24 patients were positive in 19 patients (79.1%) and were positive in 6 control subjects (30%). CONCLUSION: Fifty-three percent of the middle ear mucosae obtained from 41 patients with chronic otitis media were shown to be positive for H. pylori, and although our results suggest that the source of this bacterium is the stomach, further clinical studies are needed.

Hypoplastic pancreas and ectopic spleen as an abdominal mass: a case report.

We report a 35-year-old female patient who presented with pseudotumoral abdominal mass with final diagnosis of ectopic spleen and hypoplastic pancreas. Clinical diagnosis is difficult due to lack of symptoms. Laboratory findings are commonly non-specific; diagnosis can be confirmed by imaging studies. This patient complained only of abdominal painless mass. The laboratory findings were all within normal limits. Diagnostic images revealed ectopic spleen and absence of the dorsal pancreas. This interesting and rare combination has not been reported previously in the literature.

A new and safe technique for removing cervical esophageal foreign body.

Despite the recent advances in instrumentation and anesthesia, removal of esophageal foreign bodies remains a challenge. Endoscopic removal of foreign bodies has yielded a success rate of 80%. Surgical removal of these foreign bodies is necessary when the endoscopic manipulations fail. Localization and size of the bodies play a critical role in the method of treatment. Here we present a patient with a large stone with sharp edges located in the cervico-thoracic region which was removed after being pushed into the hypopharynx through the esophagus rather than being pushed into the stomach. The technique used proved to be effective and safe; this may be the first use of the procedure in the literature.

Coeliac crisis in adults: report of two cases.

Adult coeliac disease, in contrast to its childhood counterpart, almost always has an indolent course with a wider spectrum of clinical manifestations. Approximately half of the patients have no overt gastrointestinal symptoms and many are asymptomatic. A rare and life-threatening complication, affecting mainly children younger than 2 years of age, is the so-called coeliac crisis, a term that applies to profuse diarrhoea leading to dehydration, hypokalemia, and acidosis. We report here two cases of adult coeliac disease that presented as coeliac crisis. Coeliac disease should be a differential diagnosis in adult patients with severe acute diarrhoea and acidosis, although a rare presentation.

Is celiac sprue an etiology of amyloidosis?

Gluten-sensitive enteropathy is a chronic disease due to malabsorption, and chronic inflammatory disorders may be a cause of secondary amyloidosis. We hereby report the first case with diagnosis of amyloidosis and gluten-sensitive enteropathy.

Inflammatory myoglandular polyp: a rare cause of hematochezia.

Inflammatory myoglandular polyp is characterized by inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic change. The etiology is obscure. Mucous diarrhea, tenesmus, and hematochezia are main symptoms. We hereby report an 80-year-old man with diagnosis of inflammatory myoglandular polyp.

Are serum and biliary carcinoembryonic antigen and carbohydrate antigen19-9 determinations reliable for differentiation between benign and malignant biliary disease?

BACKGROUND/AIMS: The value of serum tumor markers carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) in the differential diagnosis of obstructive biliary disease is dubious. We aimed to define their usefulness prospectively. METHODS: Thirty-seven consecutive patients (12 female, 25 male, median age: 54, range: 19-83 years) who were referred for endoscopic retrograde cholanugiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) examination for obstructive jaundice were included (all with dilatation of biliary tree in ultrasonography or computerised tomography). Bile was obtained through the nasobiliary or external drainage catheter, placed with ERCP or PTC, respectively. Serum samples were taken from all patients at the time of acquisition of bile. Serum and bile samples were stored at -50 oC until they were tested. CA19-9 and CEA levels were measured with chemiluminescent enzyme immunoassay methods in serum and bile samples by using immulite GI-MA and CEA commercial kits, respectively (DPC(r), Los Angeles). RESULTS: In 22 patients with malignant disease, serum CEA levels were 38.6+/-115.8 ng/ml and CA19-9 were 386.9+/-409.7 U/ml, while in 15 patients with benign disease the serum CEA levels were 1.8+/-1.6 ng/ml and CA19-9 were 128.9+/-302.2 U/ml. The difference for both values was significant (p<0.05). In malignant disease bile CEA and CA19-9 levels were 160.8+/-457.8 ng/ml, 14000.9+/-19798 U/ml respectively, while in benign disease the corresponding levels were 21.08+/-48.6 ng/ml for CEA and 14818.9+/-24665.7 U/ml for CA19-9. The differences were not significant in this case (p>0.05). CONCLUSION: It was concluded that serum CA19-9 levels are increased both in malignant and benign obstructive biliary diseases, albeit more significantly in the former. However, increase in serum CEA is mostly restricted to malignant diseases. Measurement of these markers in bile is of no value.

Analysis of peripheral blood lymphocyte phenotypes and Th1/Th2 cytokines profile in the systemic immune responses of Helicobacter pylori infected individuals.

H. pylori elicits specific humoral and cellular immune responses in the mucosal immune system. However, the type and extent of T lymphocyte response in the systemic immune system is not clear for H. pylori positive patients. In this study, peripheral blood T lymphocyte phenotypes and serum Th1/Th2 based cytokines of 32 H. pylori positive patients were analyzed and compared to those of healthy controls. While alphabeta TCR(+) lymphocytes and their phenotype analysis were not significantly different to those of healthy controls, the percentage of pan gammadelta TCR(+) lymphocytes was up to 2.4 times greater in the H. pylori positive group then in healthy controls. Furthermore, significant increases in IL-10 concentrations in serum samples of H. pylori patients indicated that their immune systems had switched toward a Th2 type immune response. The correlation between phenotype and type of T cell response in the peripheral blood during H. pylori infection is discussed.

Hepatolithiasis: a Turkey experience.

BACKGROUND/AIMS: The aim of this study was to report our experience of hepatolithiasis, diagnosed in 55 patients between June 1995 and March 2003. METHODS: Fifty-five patients who underwent endoscopic retrograde cholangiopancreatography for hepatolithiasis between June 1995 and March 2003 at our institution were evaluated. Diagnosis of hepatolithiasis was based on cholangiography, ultrasonography and computed tomography. Patients with hepatolithiasis were classified according to Tsunoda classification. RESULTS: Fifty-five patients with hepatolithiasis (22 female, 33 male; mean age: 48.2 +/-14.9, range: 22-83) were included in this study. The major causes of hepatolithiasis were previous bilio-digestive surgery and Caroli disease, with rates of 49% and 14.5%, respectively. While 37 of 55 patients (67.3%) presented with only intrahepatic lithiasis, 18 patients (32.7%) had intrahepatic lithiasis associated with common bile duct (16/18, 29%) or gallbladder (2/18, 3.6%) stones. According to Tsunoda classification, 4 patients were classified as type I, 32 type II, 9 type III and 10 type IV. Patients with types I and II had significantly better stone clearance rates in comparison to those with types III and IV (p<0.05). Complete eradication of stones in the patients with proximal strictures was significantly lower than in the patients with distal strictures (p<0.01). While complete clearance of stones was achieved in 22 cases (40%), incomplete clearance was achieved in 17 cases (30.9%) with endoscopic retrograde cholangiopancreatography . Mean number of endoscopic retrograde cholangiopancreatography procedures for clearance of stones was 4 (ranges: 1-9). CONCLUSION: The etiology of hepatolithiasis in our patients is similar to that observed in Western populations and endoscopic approach appears to be an effective alternative to surgery.