The rate of mucosal healing by azathioprine therapy and prediction by artificial systems.

BACKGROUND/AIMS: We aimed to assess the effect of azathioprine on mucosal healing in patients with inflammatory bowel diseases (IBD). Artificial neural networks were applied to IBD data for predicting mucosal remission. MATERIALS AND METHODS: Two thousand seven hundred patients with IBD were evaluated. According to the computer-based study, data of 129 patients with IBD were used. Artificial neural networks were performed and tested. RESULTS: Endoscopic mucosal healing was found in 37% patients with IBD. Male gender group showed a negative impact on the efficacy of azathioprine (p<0.05). Responder patients with IBD were older than the nonresponder (p<0.05) patients. According to this study, the cascade-forward neural network study provides 79.1% correct results. In addition to a 0.16033 training error, mean square error (MSE) was taken at the 16th epoch from the feed-forward back-propagation neural network. This neural structure, used for predicting mucosal remission with azathioprine, was also validated. CONCLUSION: Analyzing all parameters within each other to azathioprine therapy were shown that which parameters gave better healing were determined by statistical, and for the most weighted six input parameters, artificial neural network structures were constructed. In this study, feed-forward back-propagation and cascade-forward artificial neural network models were used.

Seasonal clustering in inflammatory bowel disease: a single centre experience.

BACKGROUNDS AND AIMS: External stimuli are considered as possible triggers for the onset of inflammatory bowel disease (IBD), and particularly chronic ulcerative colitis (CUC) in genetically susceptible individuals. Our aims were to investigate monthly clustering-patterns in the onset of symptoms and diagnosis of IBD, as well as health seeking behavior in those individuals. MATERIALS AND METHODS: Two hundred and eighty-two consecutive patients with IBD were included. Onset of symptoms (month) and delay to diagnosis were analyzed. Kruskal-Wallis and Roger's test were used to analyze for statistical patterns in seasonal clustering. RESULTS: There were 181 males and 101 females with IBD; mean age: 40 ± 14.7 years (median: 38, range: 14-79 years). The peak number of IBD cases was seen in winter/early spring, with the lowest numbers in autumn, which reached statistical significance in the CUC group (p: 0.029). Seasonal changes were not significantly affected by gender. The time delay to diagnosis from symptom onset was 3.0 ± 2.3 months in males (median: 2, range: 0-12 months) vs 3.2 ± 3.2 months (median: 2, range: 0-18 months) in females (not statistically significant). CONCLUSION: Our results show a seasonal relation in IBD cases, particularly in CUC, which may suggest external stimuli acting as a precipitant to IBD in susceptible individuals. There was a delay between symptom onset and CUC diagnosis, which was not felt to be clinically significant.

Does granulocyte-macrophage colony-stimulating factor prevent bacterial translocation in rats with surgical trauma and obstructive jaundice?

BACKGROUND/AIMS: The incidence of sepsis can be decreased by preventing bacterial translocation, as the first step in enhanced host defense. The aim of this study was to prevent translocation and to increase Kupffer cell incidence by using granulocytemacrophage colony-stimulating factor in rats with surgical trauma and obstructive jaundice. METHODS: Seventy-five Sprague- Dawley rats were randomized into 8 groups. After calibration of laboratory conditions by Group 0, SHAM operations in Groups I, II, IIA and common bile duct ligations in Groups III, IV, IVA and V were performed. Granulocyte-macrophage colony- stimulating factor doses were 6 microg/kg/d in Groups II, IV; 1 microg/kg/d in IIA, IVA postoperatively; and 6 microg/kg/d in Group V preoperatively, for 7 days. After one week, all rats were reoperated for cecal lymph node, liver and spleen biopsies for culture and histopathology. All culture specimens were identified as positive/negative/contaminated. Survivals were recorded, and after the 21st day surviving rats were sacrificed by decapitation. RESULTS: There was no translocation in Group 0 in the three specimens of liver, cecal lymph node and spleen. Group V showed minimal (10%) positivity in only liver, and other groups ranged between 20-70% in cecal lymph node, liver and spleen tissues, respectively (p<0.05). Kupffer cell incidences were higher in the granulocyte-macrophage colony-stimulating factor given groups than in controls, and lower in common bile duct ligation groups than in SHAM groups (p<0.001). Groups 0 and V showed the best (median 20 days) and Group III the worst (median 11.7 days) survival (p<0.001). CONCLUSIONS: Not only surgical trauma but also obstructive jaundice caused high incidence of translocation, decreased number of Kupffer cells and shortened survival. Translocation ratios were decreased by granulocyte- macrophage colony-stimulating factor in the SHAM and common bile duct ligation groups. Granulocyte-macrophage colony- stimulating factor prevented the decrease in Kupffer cell incidence caused by jaundice and prolonged the survival by preventing translocation at the first step.

Open heart surgery in patients with end-stage renal failure: fifteen-year experience.

OBJECTIVE: Risk factors and results of cardiac surgery with cardiopulmonary bypass (CPB) in hemodialysis-dependent renal failure patients at our center were evaluated. METHODS: Out of 16,425 patients undergoing open heart surgery with CPB at our center between January 1991 and April 2006, 91 (0.6%) experienced hemodialysis-dependent end-stage renal failure. Preoperative, operative, and postoperative findings of two groups of patients were evaluated: those with normal renal function (control group) and those with chronic renal failure undergoing regular hemodialysis (HDRF group). Survival analyses of the hemodialysis group of patients were performed. RESULTS: In the hemodialysis group, 54 (59.3%) patients underwent coronary artery surgery, 31 (34.1%) patients had valve surgery, four (4.4%) patients had aortic surgery, and two others (2.2%) experienced concomitant coronary and peripheral artery surgery. CPB and aortic cross-clamping (ACC) times were longer in the HDRF group (p=0.000 and 0.002, respectively). There was no significant difference between the two groups with regard to either reoperations, infections, pulmonary and gastrointestinal system complications, or cerebrovascular event parameters (p=0.167, 0.341, 1.000, 1.000, and 1.000, respectively). There was no difference between groups in the postoperative development of low cardiac output (p=0.398). The early mortality rate was 7.7% (seven patients) in the HDRF group and 4.8% (780 patients) in the controls (p=0.211). The actuarial survival rates in HDRF survivors at one, two, three, four, five, and ten years were overall 86%, 80%, 68.1%, 45.4%, 20%, and 6.8%, respectively. CONCLUSIONS: Open heart surgery in hemodialysis patients is associated with a higher incidence of risks, but can be performed with acceptable operative complications and mortality with an effective hemodialysis program.

Multidrug resistance of isolated microorganisms in occluded bile duct stents.

BACKGROUND/AIM: Biliary stents have been used for benign or malignant biliary strictures, preoperative biliary drainage, resolution of biliary or pancreatic leaks, and dissolution treatment of non-extractable bile duct stones since 1979, and should be replaced at 3-6 month intervals. The aim of this cross-sectional pioneer study was to identify the microorganisms in occluded bile duct stents and to determine incidence and diagnosis of multidrug resistance of the isolated microorganisms in stents and in blood cultures. METHODS: Fifty-one patients (14F, 37M, mean age: 58.2+/-11.6 yr) with cholangitis due to occluded stents were studied consecutively and prospectively after stent replacement was done. Independent variables were age, gender, underlying disease, duration of disease, size, length and period of stents, and blood biochemistry. Dependent variables were microorganisms isolated from the stent content and blood of the patients and the results of antibiogram tests. RESULTS: Primary disease was malignant in 25 (49.0%), stent size was 7F in 30 (58.8%), and stent length was 11 cm in 11 (21.6%) and 15 cm in 12 (23.5%) of the patients. The mean period after the 1st stent application was 207.0+/-111.3 days and the last stent duration was 111.0+/-64.0 days. Isolated microorganisms from stents and blood, respectively, were Escherichia coli (E. coli) (43.4%, 20.8%), Klebsiella spp. (17.1%, 17.0%), Pseudomonas aeruginosa (P. aeruginosa) (13.2%, 18.9%) and Enterococcus spp. (10.5%, 17.0%). Isolated microorganisms showed multidrug resistance at high percentages (81.6% for stent, 81.1% for blood). ALT, AST, ALP, and direct bilirubin levels showed statistically significant differences between the benign and malignant groups. CONCLUSION: All bile duct stents are contaminated by microorganisms, of which a high majority has multidrug resistance, and they frequently cause biliary sepsis. Biliary sepsis can be prevented by changing the stents periodically and by using proper antibiotic prophylaxis.

Acute renal failure following open heart surgery: risk factors and prognosis.

BACKGROUND: Acute renal failure (ARF) development after cardiac surgery carries high mortality and morbidity. METHODS: Out of 14437 consecutive patients undergoing open-heart surgery between January 1991 and May 2001, 168 (1.16%) developed postoperative ARF mandating hemodialysis. Possible perioperative risk factors, and the prognosis of this dreadful, often fatal complication were investigated. RESULTS: The mortality rate in this group was 79.7% (134 patients). The risk factors associated with postoperative ARF were advanced age (p=0.000), diabetes mellitus (p=0.000), hypertension (p=0.000), high preoperative serum creatinine levels (p=0.004), impaired left ventricular function (p= 0.002), urgent operation (p=0.000) or reoperation (p=0.007), prolonged cardiopulmonary bypass (CPB) (p =0.000) and aortic cross-clamp (ACC) (p =0.000) periods, level of hypothermia (p =0.000), concomitant procedures (p =0.000), low cardiac output state (p =0.000), re-exploration for bleeding or pericardial tamponade (p =0.000), and deep sternal or systemic infection (p = 0.000). Of those who could be discharged from hospital, renal functions were restored in 21 patients (12.5%); however, eight patients (4.7%) became hemodialysis dependent. The mean follow-up period was 5.7+/-3.2 years (range: 4 months to 13 years; a total of 195 patient-years), and 10-year survival was 58.6+/-10.2% in the discharged patients. CONCLUSIONS: ARF development after cardiac surgery often results in high morbidity and mortality. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes.