ABSTRACT
BACKGROUND: Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36. METHODS: Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study. RESULTS: A total of 106 patients were included in this study, and 64.2% of the patients were males. Mean [± standard deviation] age was 36.8 [± 10.9] years. At baseline, mostly perianal fistulas [65.7%] were observed [n = 23]. Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%]. Extraintestinal symp- toms were observed in 24 patients [22.6%]. Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15]. Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [± 5.0] years. Improvements in work productivity and activ- ity impairment scores throughout 12 months were -24.1% [P = .003] for work time missed, -18.0% [P = .006] for impairment at work, -8.5% [P = .160] for overall work impairment, and -17.0% [P < .001] for daily activity impairment. Similarly, significant improvements [P < .001] were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline. Statistically sig- nificant improvements [P < .05] were detected for all components of Short-Form Health Survey-36 except for mental health [P = .095]. CONCLUSION: Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.
Subject(s)
Crohn Disease , Constriction, Pathologic , Crohn Disease/drug therapy , Crohn Disease/psychology , Female , Humans , Male , Quality of Life , Treatment Outcome , Tumor Necrosis Factor-alpha , TurkeyABSTRACT
BACKGROUND/AIMS: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population. MATERIAL AND METHODS: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)±ribavirin (RBV) orombitasvir/paritaprevir/ritonavir±dasabuvir (PrOD)±RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed. RESULTS: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90±54.60 U/L to 17.00±14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51±4.54 to 7.32±3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0±16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%). CONCLUSION: LDV/SOF or PrOD±RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.
Subject(s)
Anilides/administration & dosage , Antiviral Agents/administration & dosage , Benzimidazoles/administration & dosage , Cyclopropanes/administration & dosage , Fluorenes/administration & dosage , Hepatitis C, Chronic/drug therapy , Lactams, Macrocyclic/administration & dosage , Proline/analogs & derivatives , Ritonavir/administration & dosage , Sofosbuvir/administration & dosage , Sulfonamides/administration & dosage , Valine/administration & dosage , Aged , Drug Therapy, Combination , Female , Hepacivirus/drug effects , Humans , Male , Middle Aged , Proline/administration & dosage , Prospective Studies , Retrospective Studies , Treatment Outcome , TurkeyABSTRACT
BACKGROUND: Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary Flow Reserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects. METHODS: 62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography. RESULTS: CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p<0.001]. CFR is negatively correlated with disease activity scores of IBD. CONCLUSION: This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events.
Subject(s)
Coronary Circulation/physiology , Coronary Vessels/physiopathology , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/physiopathology , Microcirculation/physiology , Adult , Blood Flow Velocity/physiology , Case-Control Studies , Female , Humans , Male , Middle Aged , Risk FactorsABSTRACT
BACKGROUND/AIMS: Chronic gastritis progression is a multistep process of atrophy, intestinal metaplasia (IM), and dysplasia, which may lead to invasive carcinoma. In this study, we identified an association of colonic polyps with gastric IM in patients undergoing colonoscopy. MATERIALS AND METHODS: This retrospective case-control, cross-sectional study was conducted in a tertiary-care institution in Turkey. Pathology and endoscopy reports were reviewed. The study group comprised 400 patients with colonic adenomatous polyps, and the control group comprised 360 patients without colonic adenomatous polyps on colonoscopy. RESULTS: The risk of gastric IM was 1.42-fold higher in the study group (p<0.05). The risk of IM in patients aged ≥50 years with colonic polyps was 3.35-fold higher than in those aged <50 years (p<0.05). The risk of Helicobacter pylori infection in the study group was 1.07-folder higher than that in the control group (p<0.05). H. pylori infection prevalence was higher only in patients with high-grade colonic polyp dysplasia (p<0.05). There were no statistically significant differences in the proportion of incomplete IM between the groups (p<0.05). CONCLUSION: This study observed increased rates of gastric IM with colonic polyps. An increased risk of gastric IM was associated with higher grades of polyp dysplasia.
Subject(s)
Adenomatous Polyps/complications , Colonic Polyps/complications , Gastritis, Atrophic/etiology , Intestinal Neoplasms/etiology , Stomach Neoplasms/etiology , Stomach/pathology , Adenomatous Polyps/pathology , Adult , Age Factors , Aged , Aged, 80 and over , Case-Control Studies , Colonic Polyps/pathology , Colonoscopy , Cross-Sectional Studies , Female , Gastritis, Atrophic/pathology , Helicobacter Infections/etiology , Helicobacter pylori , Humans , Intestinal Neoplasms/pathology , Intestines/pathology , Male , Metaplasia/etiology , Metaplasia/pathology , Middle Aged , Retrospective Studies , Risk Factors , Stomach Neoplasms/pathology , Turkey , Young AdultABSTRACT
INTRODUCTION: Endometrial polyps (EPs) and colorectal polyps (CPs) are common disorders and the incidence of both increase rapidly with aging. CPs are focal lesions and incidence increases with age. AIM: In this study, we aimed to analyze retrospectively the relationship between the EPs and CPs sharing similar clinical and genetic factors in their etiopathogenesis. MATERIALS AND METHODS: This study was retrospectively performed between 2010 and 2013 and it included patients diagnosed to have eEPs. The study group and the control group consisted of patients who were diagnosed with or without EPs and who underwent colonoscopy at the same period. RESULTS: The study group was formed by 57 patients with diagnosis of EP who underwent colonoscopy during the same period. The control group consisted of 71 patients without EP examined with colonoscopy. Among 128 patients assessed in this study, 24 were diagnosed with CPs, all of which were adenomatous polyps smaller than 1cm. No hyperplastic or inflammatory polyps were diagnosed. While 18 of 57 patients with EPs had CPs, 6 of 71 control subjects had CPs. Hence, the risk of having CP was 5 times greater in patients with EP compared to those without (P < 0.05). CONCLUSION: The present study demonstrated that the prevalence of CPs increased significantly in postmenopausal patients with EPs. Recommending colonoscopy to these patients irrespective of age may be beneficial for detecting more CPs and preventing colorectal cancer.
Subject(s)
Colonic Neoplasms/epidemiology , Polyps/epidemiology , Rectal Neoplasms/epidemiology , Uterine Diseases/epidemiology , Adenomatous Polyps/epidemiology , Adenomatous Polyps/etiology , Adult , Colonic Neoplasms/etiology , Colonic Polyps/epidemiology , Colonic Polyps/etiology , Colonoscopy , Female , Humans , Intestinal Polyps/epidemiology , Intestinal Polyps/etiology , Middle Aged , Polyps/etiology , Prevalence , Rectal Diseases/epidemiology , Rectal Diseases/etiology , Rectal Neoplasms/etiology , Retrospective Studies , Risk Assessment , Turkey/epidemiology , Uterine Diseases/etiologyABSTRACT
BACKGROUND: The H. pylori eradication success is low in countries with high antibiotic resistance to H. pylori. OBJECTIVE: We retrospectively assessed the eradication rates achieved by five different regimens and aimed to compare the efficiency of bismuth enhanced sequential therapy and other treatments in a gastroenterology outpatient clinic a university-affiliated hospital. DESIGN: Our study was carried out with a retrospective cohort design. SETTING: This study assessed the gastroscopy examinations of patients. PATIENTS: A total of 621 patients were included in the study. There were 122 patients in the quadruple treatment group, 168 patients in the classical sequential treatment group, 130 patients in the bismuth enhanced sequential therapy, 113 patients in the sequential treatment with levofloxacin, and 88 patients in the hybrid treatment. MEASUREMENTS: Eradication rates of different regimens was analyzed by performing Chi-square and Tukey's honest significant difference test. RESULTS: Eradication rates by ITT and PP analysis achieved by treatment groups were 74.6 and 75.6% in the quadruple treatment; 70.2 and 70.4% in the sequential treatment with clarithromycin, 88.5 and 90.3% in the bismuth enhanced sequential therapy, 77.9 and 78.5% in the sequential treatment with levofloxacin, and 76.1 and 76.2% in the hybrid treatment. LIMITATIONS: The main limitation of our study was its retrospective nature. Different proton pump inhibitors were used in the treatment arms. CONCLUSIONS: Bismuth-enhanced sequential therapy can be recommended to overcome resistance.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Helicobacter Infections/drug therapy , Proton Pump Inhibitors/therapeutic use , Adult , Drug Therapy, Combination/methods , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , TurkeyABSTRACT
AIM: Ulcerative colitis (UC) is one of the major forms of chronic relapsing inflammatory bowel diseases. The ability to identify type, severity and responsiveness to therapy of UC using laboratory parameters has long been the aim of clinical studies. The aim of this study was to assess the relation betweenplasma viscosity (PV) and disease activity and response to medical treatment in patients with UC. MATERIAL AND METHODS: The study included 105 patients with UC and 42 healthy volunteers. Blood samples were assessed for PV, erythrocyte sedimentation rate (ESR), high sensitive C-reactive protein (hs-CRP), D-dimer, and fibrinogen. RESULTS: Patients with UC were grouped according to disease activity, i.e. active (n= 59) and remission (n= 46). PV was higher in those with active UC compared with those with UC in remission or healthy subjects. It was significantly higher in both UC refractory to steroid compared to UC responsive to steroid (p< 0.001) and UC refractory to cyclosporine compared to UC responsive cyclosporine (p= 0.003). IncreasedSimple Clinical Colitis Activity Index (SCCAI), Endoscopic Grading Scale (EGS), and Histological Disease Activity (HAD) scores were significantly associated with higher PV in patients with UC. CONCLUSION: PV is a useful marker in predicting response to steroid or cyclosporine treatment in patients with active UC. It could be replaced by ESR or hs-CRP as a measure of the acute phase response in UC since it is sufficiently sensitive. These findings may help identify patients with active UC who will require colectomy. KEY WORDS: Biomarkers, Disease activity, Medical treatment, Steroid-refractory ulcerative colitis, Ulcerative colitis.
Subject(s)
Blood Viscosity , Colitis, Ulcerative/blood , Colitis, Ulcerative/drug therapy , Adolescent , Adult , Aged , Colitis, Ulcerative/diagnosis , Female , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Malnutrition is common in patients with chronic liver disease and is associated with poor outcomes. Inadequate intake, poor quality diet, maldigestion, malabsorption, altered macronutrient metabolism, and hypermetabolism all contribute to the development of malnutrition in this patient population. Although it is generally easy to detect, clinicians often overlook malnutrition and its measurement is complicated by the lack of a simple, standardized diagnostic method. Early detection of malnutrition and multidisciplinary treatment approaches greatly increase the probability for successful outcomes.
Subject(s)
Liver Cirrhosis/complications , Malnutrition/etiology , Diet , Digestion , Eating , Gastrointestinal Absorption , Humans , Liver Cirrhosis/metabolism , Liver Cirrhosis/physiopathology , Malnutrition/physiopathology , Malnutrition/therapyABSTRACT
Dysphagia represents a difficulty in passage of solid or liquid foods from the oral cavity into the stomach and is considered as an alarm symptom of gastrointestinal system. It often indicates an organic disease and needs to be explained. In this paper, a case of 61-year-old man with posterior tongue abscess is presented.
ABSTRACT
Alpha blockers are the drugs that exert their effects by binding to alpha receptors and relaxing smooth muscles and are currently used for treatment of benign prostate hyperplasia (BPH). These drugs are often tolerated well by the patients. However, they also possess some common side effects. Hepatotoxicity, on the other hand, is quite rare. We report herein a case with the rare complication of acute hepatocellular drug induced liver injury (DILI) by administration of Alfuzosin.
Subject(s)
Device Removal/methods , Intrauterine Device Migration/adverse effects , Rectum/injuries , Adult , Female , HumansABSTRACT
BACKGROUND AND AIM: Increased incidence of coronary vascular events in patients with inflammatory bowel disease (IBD) is known. However, the association between coronary microvascular function and IBD has not been fully defined. We aimed to investigate whether coronary flow reserve (CFR) and left ventricular diastolic function were impaired in IBD patients. METHODS: Seventy-two patients with IBD (36 patients with ulcerative colitis [UC] and 36 Crohn's disease [CD]) were registered. Each subject was evaluated after a minimum 15-day attack-free period. For the control group, 36 age- and sex-matched healthy volunteers were included into the study. IBD clinical disease activity in UC was assessed by the Truelove-Witts Index (TWAS) and in CD by the Crohn's Disease Activity Index (CDAI). In each subject, CFR was measured through transthoracic Doppler echocardiography. RESULTS: Compared to the controls, the CD group and UC group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and erythrocyte sedimentation rate. Baseline diastolic peak flow velocity (DPFV) of the left anterior descending artery (LAD) was significantly higher in the IBD group (24.1±3.9 vs. 22. 4±2.9, p<0.05), and hyperemic DPFV (56.1±12.5 vs. 70.6±15.3, p<0.05) and CFR (2.34±0.44 vs. 3.14±0.54, p<0.05) were significantly lower in the IBD group than in the control group. In stepwise linear regression analysis, hs-CRP and lateral Em/Am ratio were independently correlated with CFR. CONCLUSION: CFR, reflecting coronary microvascular function, is impaired in patients with IBD. CFR and left ventricular diastolic function parameters are well correlated with hs-CRP.
Subject(s)
Colitis, Ulcerative/complications , Coronary Artery Disease/etiology , Coronary Vessels/physiopathology , Crohn Disease/complications , Fractional Flow Reserve, Myocardial , Microvessels/physiopathology , Ventricular Dysfunction, Left/etiology , Ventricular Function, Left , Adult , Biomarkers/blood , Blood Flow Velocity , Blood Sedimentation , C-Reactive Protein/analysis , Case-Control Studies , Chi-Square Distribution , Colitis, Ulcerative/blood , Colitis, Ulcerative/diagnosis , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Coronary Vessels/diagnostic imaging , Crohn Disease/blood , Crohn Disease/diagnosis , Diastole , Echocardiography, Doppler, Pulsed , Female , Humans , Inflammation Mediators/blood , Linear Models , Male , Microcirculation , Microvessels/diagnostic imaging , Middle Aged , Predictive Value of Tests , Risk Factors , Severity of Illness Index , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/physiopathologyABSTRACT
BACKGROUND/AIMS: To provide a new mathematical formula to predict liver fibrosis in patients with chronic viral hepatitis. MATERIALS AND METHODS: Patients with chronic hepatitis B and C who underwent liver biopsy at different centers were included in this study. Chronic hepatitis B was defined as immunopositivity for the hepatitis B surface antigen for at least 6 months, and chronic hepatitis C was defined as positivity for HCV RNA for at least 3 months. The histological features were evaluated by the histological activity index and fibrosis. RESULTS: In total, 1299 patients were included in the study. The distribution and the mean of the parameters of the patients were as follows: 1009 patients with chronic hepatitis B with a mean age of 45±13/years [emale/male (F/M)=47.5/52.5%] and 290 patients with hepatitis C with a mean age of 52±10.3/years [F/M=61/39%]. When the cut-off value of the REAL TEST formula"[(age x pT x AST)/(PLT/1000)]/100" in patients with hepatitis B was determined to be ≥1.37, it was found that it could predict fibrosis with 79% specificity, 78% sensitivity, 85% negative predictive value (NPV), and 70% positive predictive value (PPV) (area under the curve (AUC)=0.852, 95% CI:0.82-0.87). When the cut-off value of the REAL TEST formula in patients with hepatitis C was determined to be ≥1.99, it was found that it could predict significant fibrosis with 87% specificity, 90% sensitivity, 94.4% NPV, and 79.4% PPV (AUC:0.95, 95% CI:0.93-0.98). CONCLUSION: The REAL TEST formula results correlated with the pathological findings and may be a useful method for the evaluation of patients with chronic hepatitis B and C.
Subject(s)
Diagnostic Tests, Routine , Hepatitis B, Chronic/blood , Hepatitis C, Chronic/blood , Liver Cirrhosis/pathology , Mathematical Concepts , Adult , Age Factors , Alanine Transaminase/blood , Area Under Curve , Aspartate Aminotransferases/blood , Disease Progression , Female , Hemoglobins/metabolism , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/pathology , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/pathology , Humans , International Normalized Ratio , Liver Cirrhosis/virology , Male , Middle Aged , Platelet Count , Predictive Value of Tests , Prothrombin Time , ROC CurveABSTRACT
An unusual and rare gastric mucosal lesion histologically consisting of Russell bodies and plasma cell infiltration and termed as Russell body gastritis is presented. In the literature there are only ten such case reports and of these, seven including this present case were associated with Helicobacter pylori infection. The high rate of Helicobacter pylori infections in cases of Russell body gastritis suggests that the correlation is not merely coincidental. All data in the literature related to Russell body gastritis were scanned, and histopathologic findings and the clinical characteristics associated with such lesions were discussed.
Subject(s)
Gastritis/pathology , Gastritis/microbiology , Gastroscopy , Helicobacter Infections/complications , Helicobacter Infections/diagnosis , Helicobacter pylori/isolation & purification , Humans , Male , Middle AgedABSTRACT
Aim. Colonic polyps and thyroid nodules are common diseases and their frequency increases with age. In the literature, there is no study investigating the coexistence of colonic polyps and thyroid nodules. Therefore, this study was designed to investigate thyroid nodule prevalence in patients with colonic polyps. Material and Methods. Sixty-six patients with colonic polyps and 146 patients without colonic polyps enrolled into the study. Age and sex matched control group was composed from patients without colonic polyps. Colonoscopic examinations, thyroid ultrasonographies were performed in all patients, and TSH were measured. Results. Male/female ratio in polyp and control groups were 40/26 versus 68/78, respectively (P = 0.058). Mean ages were similar in both groups (53.3 ± 11.4 versus, 51.8 ± 11.4, P = 0.373). Thyroid nodule was detected in 44 (66.7%) patients with polyps and in 61 (41.8%) controls (P = 0.001). Patients with adenomatous polyps had 5 or more thyroid nodules compared to patients with hyperplastic polyps (P = 0.03). Thyroid nodules were more prevalent among patients aged 50 or older compared to 50 years or less (P = 0.023). Conclusion. Thyroid nodules were detected more common in patients with colonic polyps. Further studies are needed to clarify this coexistence.
ABSTRACT
BACKGROUND/AIM: To investigate the early effects of peginterferon alpha-2b plus ribavirin therapy on blood pressure and related cardiovascular risk parameters, and also insulin resistance in patients with chronic hepatitis C virus (HCV) infection. METHODOLOGY: Twenty-nine patients with chronic hepatitis C (CHC) were enrolled in the study. Twenty-four hour ambulatory blood pressure monitoring (ABPM) of all patients was recorded in the pre-treatment period, and after the 1st and 8th weeks of treatment. Lipid profile, insulin resistance (IR), body mass index (BMI), complete blood counts and transaminase levels were also recorded at the same time periods. RESULTS: Fifteen of the 29 patients studied were hypertensive before treatment. The baseline, 1st week and 8th week recordings of ABPM (daytime, nighttime, mean systolic and diastolic measurements) did not show any significant change. Among hypertensive patients, differences in pretreatment, 1st and 8th week of treatment values of median systolic and diastolic blood pressures were not statistically significant. After the 8th week, total cholesterol, LDL, HDL, hemoglobin, white blood cell, platelet and AST/ALT were significantly decreased (p<0.05). Serum triglyceride levels increased significantly (p<0.0001) and HOMA-IR decreased (p=0.07). CONCLUSION: Peginterferon alpha-2b plus ribavirin therapy did not cause any increase in blood pressure in hypertensive and normotensive CHC patients in the early period of treatment. This treatment resulted in early but not significant changes in the IR status of CHC patients.
Subject(s)
Antiviral Agents/administration & dosage , Blood Pressure/drug effects , Hepatitis C, Chronic/drug therapy , Insulin Resistance , Interferon-alpha/administration & dosage , Polyethylene Glycols/administration & dosage , Ribavirin/administration & dosage , Adult , Aged , Blood Pressure Monitoring, Ambulatory , Drug Therapy, Combination , Female , Heart Rate/drug effects , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/physiopathology , Humans , Interferon alpha-2 , Lipids/blood , Male , Middle Aged , Recombinant ProteinsABSTRACT
PURPOSE: We investigated the effectiveness of mechanical intestinal cleansing and antibiotic prophylaxis in preventing bacterial translocation (BT) during the Pringle maneuver in rabbits. METHODS: Forty-eight rabbits were allocated to one of the following four groups: a control group (group 1); an antibiotic group, given 100 mg/kg intravenous ceftizoxime (group 2); a mechanical intestinal cleansing group, given a Fleet enema (group 3); and a mechanical intestinal cleansing plus antibiotic group (group 4). After performing laparotomy, we dissected the portal region and turned the portal triad, using tape. Pringle maneuver was applied for 30 min in all groups. Blood samples were collected from the portal vein for blood culture before the Pringle maneuver. All groups underwent relaparotomy 30 min after the Pringle maneuver, to obtain portal blood, mesenteric lymph nodes (MLNs), and splenic tissue for culture. RESULTS: All cultures from the portal vein specimens taken before the Pringle maneuver were negative. The rate of bacterial isolation in the portal vein (P < 0.001), MLNs (P < 0.01), and splenic (P < 0.001) cultures was significantly lower in group 4 than in the other groups. It was also lower in group 3 than in groups 1 and 2 (P < 0.05 for all). CONCLUSIONS: The combination of mechanical intestinal cleansing and preoperative broad-spectrum antibiotics was most effective for preventing BT during the Pringle maneuver.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Translocation , Enema , Hemostasis, Surgical/adverse effects , Hemostatic Techniques/adverse effects , Animals , Antibiotic Prophylaxis , Male , RabbitsABSTRACT
INTRODUCTION: Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection, and recent reports from different countries report eradication rates lower than 80% with triple therapy. The aim of this pilot study was to investigate the efficacy of standard triple eradication regimen in long-term aspirin users. METHOD: The study population consisted of 77 aspirin using patients with dyspeptic symptoms and 79 age- and sex-matched dyspeptic patients without aspirin use as a control group. Both the study group and control patients were given lansoprazole (30 mg twice a day), clarithromycin (500 mg twice a day) and amoxicillin (1 g twice a day) (LCA) for 14 days as the eradication regimen. Patients on the study group were allowed to take aspirin during the eradication regimen (LCAAsp). Eradication was defined as the absence of H pylori as assessed with the C-urea breath test and H pylori stool antigen test 8 weeks after the end of the antimicrobial therapy. RESULTS: The H pylori eradication rate in the LCAAsp group was 64/77 [83%, 95% confidence interval (CI): 79%-94%] with intention-to-treat (ITT) analysis and 64/75 (85%, 95% CI: 82%-96%) with per protocol (PP) analysis, and the H pylori eradication rate in the LCA group was 42/79 (53%, 95% CI: 43%-65%) with ITT analysis and 42/75 (56%, 95% CI: 46%-68%) with PP analysis. The difference between the groups both with ITT analysis and with PP analysis was statistically significant (P < 0.05). CONCLUSION: These data suggest that H pylori eradication rate with standard triple eradication regimen is significantly higher among long-term aspirin users than in controls.
Subject(s)
Aspirin/therapeutic use , Helicobacter Infections/drug therapy , Helicobacter pylori/metabolism , 2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage , Amoxicillin/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anti-Ulcer Agents/administration & dosage , Case-Control Studies , Clarithromycin/administration & dosage , Drug Resistance, Microbial , Female , Helicobacter Infections/prevention & control , Humans , Lansoprazole , Male , Pilot Projects , Prospective Studies , Time Factors , Treatment OutcomeSubject(s)
Liver Diseases/diagnosis , Pregnancy Complications/diagnosis , Adult , Female , Humans , Pregnancy , Pregnancy Trimester, ThirdABSTRACT
OBJECTIVES: The need for colonoscopy is common among diabetic patients. However, there are no standards per se for bowel preparation in patients with type 2 diabetes. In this study, we evaluated the efficacy, safety, and tolerability of sodium phosphate (NaP), and the quality of bowel cleansing in relation to glycemic control and late complications. METHODS: A total of 50 consecutive type 2 diabetic patients and 50 non-diabetic patients underwent bowel preparation by NaP. Fasting blood glucose, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium, and creatinine levels were measured on the procedure day. Patients were given a tolerability questionnaire regarding symptoms. RESULTS: With regard to bowel preparation quality, optimal bowel cleansing was achieved in 35 (70%) diabetic and 47 (94%) non-diabetic patients (P = 0.002). Abdominal pain or discomfort during and an hour after the procedure was similar in both groups (P >0.05). The changes in Na, K, Ca, P and creatinine levels after NaP use did not reach statistical significance between the groups (P >0.05). In the diabetic patients, there was a significant correlation between the quality of bowel cleansing and mean age, duration of diabetes mellitus, level of hemoglobin A1c (HbA1c), fasting blood glucose level, and diabetic late complications (P <0.05). CONCLUSION: These data suggest that NaP is safe and tolerable in diabetic patients, but the quality of bowel cleansing is worse than in non-diabetic patients. These observations support the concept that the quality of bowel cleansing in those with type 2 diabetes is closely related to the duration and regulation of the disease and the presence of late complications.