Irritable bowel syndrome in patients with chronic pruritus of undetermined origin.

BACKGROUND: Chronic pruritus is an important distressing condition that is often refractory to treatment. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that occurs without an organic cause. OBJECTIVES: We aimed to investigate the relationship between chronic pruritus of undetermined origin (CPUO) and IBS. METHODS: Eighty patients with chronic pruritus (CP) of undetermined origin and fifty healthy control subjects without pruritus were included into the study. All of the participants were examined by a gastroenterologist for concomitant IBS. RESULTS: The frequency of IBS was found higher in patients with CP of undetermined origin (P: 0.02), but we did not observe any significant association between pruritus intensity and either presence of IBS (P: 0.08) or the subtypes of the syndrome (P: 0.40). Furthermore, patients with CP of undetermined origin between 40 and 60 years, female gender and longer duration of the disease were found to be significantly associated with the presence of IBS (P: 0.02, P: 0.01 and P < 0.001). CONCLUSIONS: We found that the frequency of IBS was higher in patients with CP than in healthy controls. Our study is the first report about the relation between CP of undetermined origin and IBS. Further studies with larger numbers of the patients are needed to show association between IBS and CPUO using laboratory tests to define underlying diseases such as lactose intolerance, functional dyspepsia and emotional diseases.

Evaluation of Barrett's esophagus with CK7, CK20, p53, Ki67, and COX2 expressions using chromoendoscopical examination.

Barrett's esophagus (BE) is a complication of chronic gastroesophageal reflux disease and can be diagnosed when there is an endoscopically irregular Z-line and intestinal metaplasia (IM) in a biopsy obtained lower esophagus. It is still not clear whether IM in the gastric cardia or columnar mucosa without IM in the lower esophagus have any significance as BE, which is considered as preneoplastic. The aim of the study was to determine the immunohistochemical features of BE and columnar mucosa in the distal esophagus and also to evaluate the value of chromoendoscopy in the diagnosis of BE in a prospective manner. A total of 12 chromoendoscopic biopsies (six from normal-looking unstained esophagus and six from esophageal mucosa stained with methyl blue suspicious of BE) were taken from 111 cases who underwent endoscopy because of a variety of upper gastrointestinal symptoms. Immunohistochemical analysis was performed using CK7, CK20, p53, Ki67, and cyclooxygenase 2 (COX2). Of the 111 cases, 19 cases with carcinoma (nine adeno, six squamous, four undifferentiated carcinomas) and 17 cases with normal squamous epithelium were excluded, while 75 cases showing columnar epithelium, including 46 (61.3%) with IM and 29 (38,7%) without IM, were further evaluated immunohistochemically. CK7 was observed in surface, crypt, and glandular epithelium, whereas CK20 was expressed in surface and superficial crypt epithelium. No significant difference was observed between the Barrett and non-Barrett type of CK7/20 staining pattern (P > 0,05). Expression of p53 did not show any difference between BE and columnar mucosa without IM, whereas COX2 expression was significantly increased in BE (P < 0.05) in comparison with columnar mucosa without IM. Ki67 expression was significiantly higher both in upper and lower crypts in BE (P < 0.05). The present study showed that a Barrett pattern does not seem to exist; however, the analysis of COX2 expression and the Ki67 proliferation fraction by immunohistochemistry can be used to separate BE from non-Barrett's metaplasia of the distal esophagus. In our point of view, the immunohistochemical detection of p53 expression in Barrett's metaplasia stage is useless as a marker for early detection of high-risk patients.

Factors influencing skin ageing in a Mediterranean population from Turkey.

BACKGROUND: Skin ageing is a continuous process, with intrinsic factors determining which extrinsic factors (chronic sun exposure and other environmental factors, particularly smoking) have the greatest effect. AIM: To investigate the effects of lifestyle and environmental factors on skin ageing in a Mediterranean population from Ankara, Turkey. METHODS: In total, 574 (337 women, 237 men; age range 18-89 years) were enrolled into the study. Data were collected on age, gender, weight, height, body mass index (BMI), skin phototype, smoking status, consumption of alcohol (> 3 units/week) and coffee (> 1 cup/day), sun exposure, use of sunscreen and sunglasses, and involvement in sports and physical activities. The Daniell skin-wrinkling grading system was used as a marker of skin ageing. RESULTS: We found that male gender, chronic sun exposure and number of pack-years of cigarette smoking significantly contributed to the formation of facial wrinkles. There was a negative correlation between facial wrinkling and the use of sunscreen and sunglasses and facial wrinkling (P < 0.001 for both). We did not find any significant association between wrinkling score and alcohol consumption, coffee consumption, sports participation or d skin phototype. Moreover, wrinkling score was significantly higher in patients with a BMI < 25 kg/m(2) than in patients with a BMI > 25 kg/m(2) (P < 0.018). Multiple logistic regression analysis was conducted after adjusting for age, gender, smoking status, alcohol consumption, skin phototype, sun exposure, and use of sunglasses and topical sun protection. We found that gender and age were significantly associated with skin ageing (P < 0.014 and < 0.001, respectively). CONCLUSION: In this study, older age, male gender, low BMI, smoking and chronic sun exposure had a negative influence on skin ageing in a Turkish population.

Association of methylenetetrahydrofolate reductase C677T-A1298C polymorphisms with risk for esophageal adenocarcinoma, Barrett's esophagus, and reflux esophagitis.

Incidence of the esophagus adenocarcinoma has been dramatically increasing in Western countries since the last decade. Gastroesophageal reflux disease and Barrett's esophagus are risk factors for adenocarcinoma. Methylenetetrahydrofolate reductase (MTHFR) genes play a key role not only in folate metabolism but also in esophagus, stomach, pancreatic carcinoma, and acute leukemias. Studies have suggested that genetic polymorphisms of MTHFR (C677T) may clarify the causes and events involved in esophageal carcinogenesis. In this study, we evaluated MTHFR C677T and A1298C polymorphisms, and vitamin B12, folate, and plasma homocystein levels in patients with esophageal adenocarcinoma (EAC), Barrett's esophagus (BE), chronic esophagitis, and healthy controls (n = 26, n = 14, n = 30, and n = 30, respectively). The mean age of patients in the EAC and BE groups was significantly higher compared with the control group (P < 0.001, P = 0.003, respectively). In all patient groups, serum folate levels were significantly lower than that of the control group (P < 0.01, P < 0.05, and P < 0.01, respectively). There was no statistically significant association between folate levels and MTHFR gene polymorphisms. No differences were found in terms of MTHFR gene polymorphisms, homocystein, and B12 levels among the groups. MTHFR gene polymorphisms and folate deficiency are not predictors of early esophageal carcinoma. However, further studies using larger series of patients are needed to evaluate the effect of genetic polymorphisms in the folate metabolic pathway and to clarify the role of folate deficiency and folate metabolism in the development of esophagus adenocarcinoma.

Management of residual cavity after partial cystectomy for hepatic hydatidosis: comparison of omentoplasty with external drainage.

OBJECTIVE: To investigate the role of two approaches to the operative treatment of hepatic hydatid cysts. DESIGN: Prospective study. SETTING: University and teaching hospital, Turkey. SUBJECTS: 108 patients with single uncomplicated hydatid cysts who were operated on in two clinics between 1990 and 1995. INTERVENTION: Introflexion and omentoplasty or external drainage after partial cystectomy in single uncomplicated hydatid cysts more than 5 cm in size. MAIN OUTCOME MEASURES: Morbidity, mortality, and hospital stay. RESULTS: The median hospital stay after introflexion and omentoplasty was 8 days (range 3-15), which was significantly shorter than that after external drainage (12 days, range 7-20). There were 2/35 postoperative complications in the former group compared with 17/73 in the drainage group (p = 0.03). There was one death after introflexion and omentoplasty. CONCLUSION: Introflexion and omentoplasty after partial cystectomy for a single uncomplicated hydatid cyst caused significantly fewer complications than external drainage, and patients left hospital sooner.

The effects of free oxygen radical scavenger and platelet-activating factor antagonist agents in experimental acute pancreatitis.

This study was done to evaluate the possible preventive effects of reactive oxygen species (ROS) scavenger agent desferrioxamine (DFX) and platelet-activating factor (PAF) antagonist agent ginkgo biloba (GB) in an experimental acute pancreatitis model. Seventy-eight CD-1 mice were divided into six groups consisting of 10-13 mice. Induction of pancreatitis was achieved by cerulein injection in groups 2-5. The first group was control, whereas DFX and GB were used alone or in combinations as preventive agents in groups 3-5. DFX or GB were injected to the mice in groups 6 and 7 to evaluate any toxic effect. The assessment of the pancreatic edema and inflammation, the measurement of the amylase and the pancreatic weight and the measurement of the pancreatic tissue oxidative capacity by chemiluminescence method were the parameters to evaluate pancreatitis. Although the results indicate DFX and GB alone or in combinations have significant preventive roles, this was not a complete prevention.

Effect of mangan-desferrioxamin in the prevention of peritoneal adhesions.

An experimental study was carried out using mangan-desferrioxamin chelate, an effective iron-chelating and free oxygen radical scavenging agent, to prevent post-operative peritoneal adhesions in 40 Wistar albino rats. The density of adhesions was evaluated and group scores obtained. The means score (2.5 +/- 0.87) for the group of rats treated with mangan-desferrioxamin was significantly different (P < 0.001) (95% confidence interval 0.6 to 1.6) from that of the control group(mean score 3.9 +/- 0.3). This favourable effect of mangan-desferrioxamin in the prevention of post-operative adhesions should encourage further research to determine the mechanisms of action.