Impact of intestinal ultrasound with a portable system in the management of Crohn's disease.

BACKGROUND: Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn's disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients. METHODS: A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients' clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD). RESULTS: The initial clinical-management decision was changed in 47 patients (40.2%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2% to 90.6% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD ≥3) assessment was shown to be comparable to that of IUS (94% vs 91%). The sensitivity for disease presence was 95% with colonoscopy and 94% with the IUS assessment. CONCLUSION: IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.

Comparison of the Efficacy of Entecavir and Tenofovir in Reducing Hepatocellular Carcinoma Risk in Chronic Hepatitis B Patients: A Real-Life Study in Turkey.

BACKGROUND: It is controversial whether entecavir or tenofovir differs in reducing hepatocellular carcinoma (HCC) risk. We aimed to compare the efficacy of entecavir and tenofovir in reducing HCC risk in chronic hepatitis B (CHB) patients. METHODS: This retrospective study included 607 nucleos(t)ide naive CHB patients who had received entecavir or tenofovir. Patients who developed HCC during the first 12 months of therapy were excluded. Cumulative HCC incidences at years 2, 3, 4, 5 and 10 were compared between entecavir and tenofovir groups. Factors associated with HCC were determined by univariate and multivariate analyses. RESULTS: Nineteen (3.1%) patients developed HCC, 12 (4.8%) in entecavir group and 7 (1.9%) in tenofovir group (P = .045). In the entire cohort, cumulative HCC incidences at years 2, 3, 4, 5 and 10 were 1.8%, 2.9%, 4.4%, 5.2% and 9.9% in entecavir group, and 0.6%, 2.4%, 2.4%, 2.4% and 3.7% in tenofovir group, respectively (log-rank P = .130). In multivariate analysis, age ≥50 years, cirrhosis, decompensated cirrhosis, high GGT and low platelet levels were associated with HCC in the entire cohort. In advanced fibrosis/cirrhosis cohort, cumulative HCC incidences at years 2, 3, 4, 5 and 10 were 4.6%, 7.1%, 8.6%, 12.1% and 15.5% in entecavir group, and 1.8%, 5.6%, 5.6%, 5.6% and 8.5% in tenofovir group, respectively (log-rank P = .267). In multivariate analysis, age ≥50 years, decompensated cirrhosis, high GGT and low platelet levels were associated with HCC in the advanced fibrosis/cirrhosis cohort. CONCLUSION: Entecavir and tenofovir are similarly effective in reducing HCC risk in CHB patients.

The Effect of Laparoscopic Sleeve Gastrectomy on Nonalcoholic Fatty Liver Disease.

Obesity is associated with nonalcoholic fatty liver disease which is one of the most common causes of chronic liver disease. FibroScan is a noninvasive tool for liver stiffness measurement and controlled attenuation parameter to evaluate liver steatosis and fibrosis. We aimed to demonstrate the effect of laparoscopic sleeve gastrectomy on liver steatosis and fibrosis. Of the 120 consecutive patients screened, 72 were enrolled in this study. FibroScan M probe and XL probe were used for the evaluation of liver steatosis and fibrosis. Fifty-two patients (72.2%) were female individuals and 20 (27.8%) were male individuals; the mean age was 37.9±10.4 years. Percentage of excess weight loss was significant at the third and sixth months: 57.2±18.3 (P<0.05) and 81.4±24.6 (P<0.05), respectively. Mean preoperative controlled attenuation parameter and liver stiffness measurement values were 309.2±68.7 dB/m and 7.5±5.0 kPa, respectively, and significantly declined to 217.4±56.4 dB/m and 5.6±2.5 kPa, respectively, at sixth postoperative month (P<0.001 and <0.01, respectively). These results suggest that laparoscopic sleeve gastrectomy is associated with significant improvement in liver steatosis and fibrosis. Bariatric surgery has a beneficial effect on nonalcoholic fatty liver disease in morbidly obese patients.

The use of Ankaferd in diverticular bleeding: two case reports.

Bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Using epinephrine injection, heater probe or bipolar coagulation, endoclips and endoscopic band ligation all have been shown in small case series to achievehemostasis. In the present two cases, we evaluated the effectiveness of Ankaferd Blood Stopper in colonic diverticular hemorrhage.

Relationship between obstructive sleep apnea severity index and left ventricular function and volume.

BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) causes increased cardiovascular morbidity and mortality, including systemic arterial hypertension, coronary heart disease, heart rhythm and conduction disorders, heart failure and stroke. In our study, we aimed to assess left ventricular mass and myocardial performance index (MPI) in OSA patients. DESIGN AND SETTING: A cross-sectional study conducted between May 2007 and August 2009 in a tertiary hospital in Istanbul, Turkey. PATIENTS AND METHODS: Forty subjects without any cardiac or pulmonary disease referred for evaluation of OSA had overnight polysomnography and echocardiography. According to the apnea-hypopnea index (AHI), subjects were classified into three groups; mild OSA (AHI: 5-14/h; n=7), moderate OSA (AHI: 15-29/h; n=13), and severe OSA (AHI: ;ge;30/h; n=20). The thickness of the interventricular septum (IVS) and left ventricular posterior wall (LVPW) were measured by M-mode along with left ventricular mass (LVM) and LVM index (LVMI). The left ventricular MPI was calculated as (isovolumic contraction time + isovolumic relaxation time)/aortic ejection time by Doppler echocardiography. RESULTS: No differences were observed in age or body mass index among the groups, but blood pressures were higher in severe OSA compared with moderate and mild OSA. In severe OSA, the thickness of the IVS (11.6 [1.7 mm]), LVPW (10.7 [1.7 mm]), LVM (260.9 [50.5 g]), and LVMI (121.9 [21.1g/m2]) were higher than in moderate OSA (9.4 [1.3 mm]; 9.9 [1.6]; 196.4 [35.2]; 94.7 [13.2 g/m2], respectively) and mild OSA (9.8 [2.4 mm], 8.9 [2.0 mm], 187.6 [66.2 g], 95.8 [28.6 g/m2], respectively). In severe OSA, MPI (0.8 [0.2]) was significantly higher than in mild OSA (0.5 [P<.01]) but not significantly higher than moderate OSA (0.8 [0.1]). CONCLUSIONS: OSA patients have demonstrable cardiac abnormalities that worsen with the severity of apnea. The MPI may have utility in subsequent OSA studies, possibly as a surrogate outcome measure.