The prognostic significance of the risk scores at upper gastrointestinal bleeding.

BACKGROUND: Upper gastrointestinal system (GIS) bleeding is one of the most common causes of mortality and morbidity. The predictive values of pre-endoscopic Rockall score (PERS), full Rockall score (FRS), Glasgow-Blatchford score (GBS), pre-endoscopic Baylor score (PEBS), and full Baylor score (FBS) to predict bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death are investigated in our study. METHODS: This study was retrospectively conducted in patients admitted to emergency department with upper GIS bleeding. Demographic and clinical characteristics of the patients were recorded. The relationships of the aforementioned scores with in-hospital termination, bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death were explored. RESULTS: The study included a total of 420 subjects, of which 269 (64%) were men. All scoring systems were able to predict transfusion need and GBS was superior to other scores (P < 0.0001). In terms of endoscopic treatment, it was determined that only PERS, FRS, and FBS were statistically significant in predicting ability and PERS >3, FRS >5 and FBS >10 patients needed endoscopic treatment. All scoring systems were able to predict rebleeding. In comparison of two groups for rebleeding, it was found that PEBS was better able to predict bleeding during follow-up than both FRS and FBS, and PERS was better able to predict bleeding during follow-up than both FRS and FBS. All scoring systems were able to predict mortality. FRS and PERS scores had a greater discriminatory power for predicting death than the rest of the scores (P < 0.001). CONCLUSION: All scoring systems were effective for predicting need for blood transfusion, rebleeding, and death. GBS had more predictive power for transfusion need, PERS and PEBS for rebleeding, and FRS for mortality. PERS, FRS, and FBS were found to be effective in predicting endoscopic treatment.

Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P < 0.001) but similar reduction in mean dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy.

Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools.

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26-307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67-300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1-12) before, and 2.63±1.82 and 2 (0-7) after circumcision. Improvement was statistically significant (P<0.0001). No correlation could be found between ejaculation time and PEDT scores. Circumcision during adulthood does not adversely affect ejaculatory function; it may slightly improve. However, it could not be interpreted as a justification for circumcision in men with premature ejaculation (PE).

Orchiectomy performed in two patients with brucella orchitis mimicking testicular tumour / Orquiectomía realizada en dos pacientes con orquitis brucelosa semejante a un tumor testicular

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis ofbrucellosis was made.

La brucelosis es una zoonosis causada por cocobacilos gram negativos, y es una enfermedad infecciosa endémica en Turquía. La infección generalmente se adquiere como resultado del contacto directo con animales infectados o por consumo de leche o queso recién producidos a partir de ellos. Existe un amplio espectro de signos y síntomas clínicos de la brucelosis. Muchos sistemas, incluyendo los sistemas musculoesquelético, cardiovascular, gastrointestinal y génitourinario, pueden estar implicados en la brucelosis. El sistema génitourinario se ve afectado en 2% a 20% de los casos con brucelosis. Las formas más comunes de brucelosis son la epidídimo-orquitis, el absceso testicular, y la atrofia. La prueba de aglutinación de suero para detectar la presencia de anticuerpos es una prueba confiable en pacientes con síntomas urogenitales. Se ha hallado que la terapia antibacteriana combinada y a largo plazo son eficaces en la brucelosis. Presentamos dos casos sometidos a orquiectomía debido a una masa testicular antes de que se realizara el diagnóstico de brucelosis.

Orchiectomy performed in two patients with Brucella orchitis mimicking testicular tumour.

Brucellosis is a zoonosis caused by gram negative coccobacilli and it is an endemic infectious disease in Turkey. Infection is usually acquired as a result of direct contact with infected animals or by consuming milk or cheese freshly made from them. There exists a wide spectrum of clinical signs and symptoms in brucellosis. Many systems including musculoskeletal, gastrointestinal, cardiovascular and genitourinary may be involved in brucellosis. The genitourinary system is affected in 2% to 20% of the cases with brucellosis. The most common forms of brucellosis are epididymo-orchitis, testicular abscess and atrophy. The serum agglutination test to detect the presence of antibodies is a reliable test in patients with urogenital symptoms. Long-term and combined antibacterial therapy have been found to be effective in brucellosis. We present two cases undergoing orchiectomy because of testicular mass before the diagnosis of brucellosis was made.

Comparison of intrathecal hyperbaric and isobaric levobupivacaine in urological surgery.

AIM: The aim of our study was to compare the efficacy of hyperbaric and isobaric solutions of intrathecal levobupivacaine for transurethral endoscopic surgery. METHODS: Urological patients who were scheduled for elective surgery under spinal anesthesia were enrolled. The heavy group received 13.5 mg of hyperbaric levobupivacaine, while the plain group received 13.5 mg isobaric levobupivacaine, both intrathecally in a 3 mL total volume. Sensory and motor block, hemodynamic parameters, pain scores, adverse effects, and analgesic requirements of the patients were recorded. RESULTS: Values of the time to onset of T10 sensory block, time to maximum sensory block, regression to L1 dermatome, time to motor block Bromage 1, time to motor block Bromage 3, and time to the end of motor block (Bromage 0) were all smaller in group 1 than in group 2 (all P values <0.05). No difference between the groups with regard to time to two segment regression of sensory block could be detected. The mean duration of initial analgesic effect, extent of maximal block, and side effects were the same in both groups (P>0.05). CONCLUSIONS: We concluded that the clinical efficacy of hyperbaric levobupivacaine was superior to the isobaric form in spinal anesthesia for transurethral resection.

Leptin levels in gingival crevicular fluid during orthodontic tooth movement.

OBJECTIVES: To test if leptin can be detected in the gingival crevicular fluid (GCF) around moving teeth, and to determine whether any changes occur during orthodontic tooth movement. MATERIALS AND METHODS: An upper canine requiring distal movement served as the test tooth; the contralateral canine was used as a control tooth. The control tooth was included in the orthodontic appliance, but was not subjected to the orthodontic force. GCF sampling from the distal sites of the test and control teeth was done at baseline, 1 hour, 24 hours, and 168 hours. RESULTS: Leptin concentrations of the test teeth decreased in a time-dependent manner. When compared with the baseline measurement, the decrease was significant at 168 hours (P < .05). CONCLUSIONS: The concentration of leptin in GCF is decreased by orthodontic tooth movement; the results of the present study also suggest that leptin may have been one of the mediators responsible for orthodontic tooth movement.

The effects of Gingko biloba, vitamin E and melatonin on bacterial translocation in thioacetamide-induced fulminant hepatic failure in rats.

BACKGROUND AND STUDY AIMS: Bacterial translocation (BT) has been implicated in the development of infectious complications in many serious clinical conditions such as fulminant hepatic failure (FHF). We aimed to investigate the effects of Gingko biloba (GB), vitamin E (Vit E) and melatonin on intestinal oxidative damage and BT in thioacetamide (TAA)-induced FHF in rats. MATERIALS AND METHODS: A total of 42 rats were divided into five groups. Group 1 (n = 8) was the control group. Group 2 (n = 10) was the TAA group, in which rats received 350 mg/kg TAA daily by the intraperitoneal (ip) route for 3 days. Oral 100 mg/kg GB per day was administered to group 3 (n = 8), oral 200 mg/kg Vit E per day to group 4 (n = 8) and ip 3 mg/kg melatonin per day to group 5 (n = 8) 48 h prior to the first TAA injection and was continued for 5 consecutive days. RESULTS: When compared with the control group, serious hepatic and intestinal oxidative damage, increased Escherichia coli counts in ileal aspirates and high BT frequencies were observed in the TAA group (all p < 0.0001). Only GB treatment attenuated hepatic oxidative damage (p < 0.0001). There was no difference in intestinal oxidative damage, E. coli counts in ileal aspirates and BT frequency between TAA and the other antioxidant treatment groups (p > 0.05). CONCLUSION: Our results suggest that intestinal oxidative damage plays a major role in the development of BT by disrupting the barrier function of intestinal mucosa.

Increased advanced oxidation protein products in Behçet's disease: a new activity marker?

BACKGROUND: Behçet's disease (BD) is a chronic inflammatory disease with unknown pathogenesis. As various functions of neutrophils in peripheral blood, such as chemotaxis, phagocytosis and generation of reactive oxygen species (ROS) increase in BD, ROS-mediated oxidative stress related to neutrophil activation may have an important role in the pathogenesis of BD. OBJECTIVES: To investigate the importance of neutrophil activation as the main source of oxidative stress through protein oxidation in the pathogenesis of BD, and also to investigate whether one of the products of protein oxidation, advanced oxidation protein products (AOPP), may be used as an activity marker for BD. METHODS: Patients with BD (n = 49), at active and inactive stages, with or without evidence of uveitis, and healthy volunteers (n = 40) were entered into the study. A full blood count, peripheral blood smears, routine biochemical analyses, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measurements were performed in all patients preceding the study. Plasma myeloperoxidase (MPO) activity, representing neutrophil activation, and biomarkers of oxidative stress reflecting protein oxidation, such as levels of AOPP and thiol, were measured spectrophotometrically. Statistical comparisons were made using Mann-Whitney U-tests, Student's t-tests, anova/post-anova tests and correlation analyses. RESULTS: In all patients, the results of full blood count, peripheral blood smears and routine biochemical analyses were in the normal range, but mean values of CRP and ESR were higher than laboratory reference values. Plasma MPO activity and AOPP levels were found to be higher and thiol values lower in the total patient group and individual subgroups than in controls. Patients with active BD had significantly higher MPO and AOPP levels and lower thiol levels than patients with inactive BD. There was no difference between uveitis-positive and uveitis-negative subgroups in MPO and thiol levels, but AOPP levels were lower in the latter group. Patients with active BD +/- uveitis were shown to have increased MPO and AOPP but decreased thiol levels in comparison with the inactive BD, uveitis-negative subgroup. There were strong positive correlations between ESR and CRP, ESR and MPO, ESR and thiol, ESR and AOPP, CRP and MPO, CRP and AOPP, MPO and AOPP, and thiol and AOPP levels in patients with BD. CONCLUSIONS: Based on this first study, in which MPO-mediated AOPP formation has been demonstrated, it may be suggested that activated neutrophils may play an important role in the pathogenesis of BD and that chlorinated oxidants of neutrophil origin may lead to oxidative stress, notably protein oxidation. Therefore, AOPP may be a useful marker for monitoring the progress and the severity of the disease activity.

Investigation of the hypothalamo-pituitary-adrenal axis (HPA) by 1 microg ACTH test and metyrapone test in patients with primary fibromyalgia syndrome.

Primary fibromyalgia syndrome (PFS) is characterized by widespread chronic pain that affects the musculoskeletal system, fatigue, anxiety, sleep disturbance, headache and postural hypotension. The pathophysiology of PFS is unknown. The hypothalamic-pituitary-adrenal (HPA) axis seems to play an important role in PFS. Both hyperactivity and hypoactivity of the HPA axis have been reported in patients with PFS. In this study we assessed the HPA axis by 1 microg ACTH stimulation test and metyrapone test in 22 patients with PFS and in 15 age-, sex-, and body mass index (BMI)- matched controls. Metyrapone (30 mg/kg) was administered orally at 23:00 h and blood was sampled at 08:30 h the following morning for 11-deoxycortisol. ACTH stimulation test was carried out by using 1 microg (iv) ACTH as a bolus injection after an overnight fast, and blood samples were drawn at 0, 30 and 60 min. Peak cortisol level (659.4 +/- 207.2 nmol/l) was lower in the patients with PFS than peak cortisol level (838.7 +/- 129.6 nmol/l) in the control subjects (p < 0.05). Ten patients (45%) with PFS had peak cortisol responses to 1 microg ACTH test lower than the lowest peak cortisol detected in healthy controls. After metyrapone test 11-deoxycortisol level was 123.7 +/- 26 nmol/l in patients with PFS and 184.2 +/- 17.3 nmol/l in the controls (p < 0.05). Ninety five percent of the patients with PFS had lower 11-deoxycortisol level after metyrapone than the lowest 11-deoxycortisol level after metyrapone detected in healthy controls. We also compared the adrenal size of the patients with that of the healthy subjects and we found that the adrenal size between the groups was similar. This study clearly shows that HPA axis is underactivated in PFS, rather than overactivated.