Assessment of venous leg symptoms in patients with hemorrhoidal disease (VEIN-HEMORRHOID study).

BACKGROUND: Coexistence of dilating venous diseases in different vascular territories has raised the idea that they have similar vascular wall abnormality in their evolutionary process. Accordingly, we aimed to evaluate venous leg symptoms in patients with hemorrhoidal disease (HD) by means of VEINES-Sym questionnaire. MATERIALS AND METHODS: The study involved 249 consecutive patients who underwent colonoscopy and met the inclusion criteria. Presence and grading of HD were made according to Goligher's classification. All patients were examined for the existing of varicose vein and classified in respect of CEAP classification. All participants were requested to answer the VEINES-Sym questionnaire. RESULTS: There was not statistically significant differences between the patients without HD (grade 0 or I) and with HD (Grade II or III) in respect to clinical characteristics except female predominance in hemorrhoid group (p = 0.07). Scores of heavy legs, swelling, burning sensation, restless leg, throbbing, tingling, and total VEINES score were significantly lower (ie: worse) in hemorrhoid group. Logistic regression analysis revealed that female gender and total VEINES score were independently associated with HD (OR: 2.03, 95% CI: 1.17-3.52, p = 0.01; OR: 0.96, 95% CI: 0.92-0.99, p = 0.02, respectively). Among all venous leg symptoms, severity of heavy legs, night cramps, swelling and aching were significantly correlated with the grades of HD. CONCLUSION: We have shown significant association between the HD and venous leg symptoms reflected by total VEINES score and significant correlation between the HD grade and venous leg symptoms severity including heavy legs, swelling, night cramps and aching legs.

Serum insulin like growth factor-1 (IGF-1) and insulin like growth factor binding protein-3 (IGFBP-3) levels in liver cirrhosis.

BACKGROUND/AIMS: Impaired growth hormone-insulin like growth factor system in hepatic cirrhosis leads to cirrhosis-related complications. In this study, we aimed to investigate whether serum levels of insulin like growth factor-1 and insulin like growth factor binding protein-3 are related to the level of hepatic dysfunction, clinical grade, and etiologic factors of the disease in patients with liver cirrhosis. METHODS: Forty-two patients with liver cirrhosis who were diagnosed by means of clinical findings, endoscopy, imaging studies, or histopathology were enrolled in the study. An age- and sex-matched control group was comprised of 37 healthy controls with no signs of liver disease by clinical or laboratory findings. The demographic features (age, sex, height, and weight) and serum levels of liver function tests, urea, creatinine, sodium, potassium, insulin like growth factor-1, and insulin like growth factor binding protein- 3 and hemogram values were recorded for each individual. The patients were grouped according to Child Pugh classification and etiology. RESULTS: Insulin like growth factor-1 and insulin like growth factor binding protein-3 levels were significantly lower in the cirrhotic group in comparison to the control group (p<0.005). A statistically significant decrease in levels of insulin like growth factor-1 and insulin like growth factor binding protein-3 was correlated with the degree of liver dysfunction, namely, lowest decrease in Child Pugh class A and highest decrease in class C. With respect to etiology, insulin like growth factor- 1 levels of alcohol-related liver cirrhosis were significantly lower than those of hepatitis B- related cirrhosis. There was no relation between insulin like growth factor binding protein-3 level and etiology. In the cirrhotic group, insulin like growth factor- 1 level was positively correlated with serum albumin and negatively correlated with serum creatinine and sodium levels and spleen size. Likewise, insulin like growth factor binding protein-3 level was positively correlated with serum albumin. There was a negative correlation between insulin like growth factor binding protein-3 level and serum bilirubin and spleen size. CONCLUSIONS: Insulin like growth factor-1 and insulin like growth factor binding protein-3 levels are related to the level of clinical impairment and were independent of the etiology. They may serve as novel markers of hepatocellular dysfunction.