A rare congenital liver anomaly: Hypoplasia of left hepatic lobe.

Morphologic anomalies of liver, as opposed to many other visceral organs, are very rare. Hypoplasia or agenesis of left lobe of the liver is defined as the absence of liver tissue on the left side of liver without previous disease or surgery. It is usually an incidental finding revealed by imaging exams or during abdominal surgery. A 44-year-old female patient was admitted to the hospital for abdominal pain and discomfort. Physical examination revealed no specific abnormality. Routine laboratory tests were normal. Imaging studies showed the absence of the left hepatic lobe. She had no history of surgery, trauma or liver disease and was diagnosed as having congenital hypoplasia of left hepatic lobe. Anomalies of hepatic morphology are due to developmental defects during embryogenesis and are rarely seen. They are generally diagnosed incidentally based on imaging techniques. Early diagnosis of such an anatomical anomaly is necessary for surgical planning, for appropriate evaluation of intraoperative surgical findings, and for the design of the postoperative approach to therapy.

Factors affecting complication rates of percutaneous nephrolithotomy in children: results of a multi-institutional retrospective analysis by the Turkish pediatric urology society.

PURPOSE: We assessed factors affecting complication rates of percutaneous nephrolithotomy in children. MATERIALS AND METHODS: We retrospectively evaluated data on 1,205 renal units in 1,157 children treated with percutaneous nephrolithotomy at 16 Turkish centers between 1991 and 2012. Of the patients 28.3% had a history of urolithiasis. Complications were evaluated according to the Satava classification system and modified Clavien grading system. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: A total of 515 females and 642 males were studied. Mean ± SD patient age was 8.8 ± 4.7 years (range 4 months to 17 years). Mean ± SD stone size, operative time and postoperative hospital stay were 4.09 ± 4.06 cm(2), 93.5 ± 48.6 minutes and 5.1 ± 3.3 days, respectively. Postoperative stone-free rate was 81.6%. A total of 359 complications occurred in 334 renal units (27.7%). Complications were intraoperative in 118 cases and postoperative in 241. While univariate analysis revealed that stone history, positive urine culture, operative time, length of hospitalization, treatment success, punctured calyx and location of the stone significantly affected the complication rates (p <0.05), operative time, sheath size, mid calyceal puncture and partial staghorn formation were the statistically significant parameters affecting complication rates on multivariate logistic regression analysis. CONCLUSIONS: Percutaneous nephrolithotomy is the treatment of choice for most renal calculi in children. The technique is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.

The relationship between resistin and ghrelin levels with fibrosis in nonalcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. It is generally accepted that insulin resistance is a pathophysiological factor in the development of NAFLD. In the present study, the aim was to determine the relationship between resistin and ghrelin levels, which were found to be closely related to insulin resistance and fibrosis scores in NAFLD. MATERIALS AND METHODS: A total of 40 (21 male, 19 female) NAFLD patients whose diagnosis was confirmed with biopsy and 40 (18 male, 22 female) healthy controls were included in the study. RESULTS: In the comparison of resistin and ghrelin levels, only resistin values were found to be significantly higher in NAFLD group while there was no significant difference in ghrelin values (respectively P < 0.05; P = 0.078). In according to the fibrosis groups there was no difference about fasting plasma glucose, insulin values, Homeostatic Measurement Assessment-Insulin Resistance measurements and also resistin and ghrelin levels. CONCLUSION: It has been understood that insulin resistance plays an important part in NAFLD. Larger studies are required that investigate the gene expression of hormones influencing insulin resistance, particularly resistin and ghrelin in order to determine their role in NAFLD.

Long-term efficacy and safety of lamivudine, entecavir, and tenofovir for treatment of hepatitis B virus-related cirrhosis.

BACKGROUND & AIMS: Data are limited on the efficacy and safety of tenofovir and entecavir when given for more than 1 year to patients with hepatitis B-related cirrhosis. We investigated the long-term safety and efficacy of these antiviral drugs in patients with chronic hepatitis B virus (HBV) infection, with compensated or decompensated cirrhosis, and compared results with those from lamivudine. METHODS: We performed a retrospective analysis of data from 227 adult patients with chronic HBV infection who were diagnosed with cirrhosis, beginning in 2005, at 18 centers throughout Turkey. There were 104 patients who had decompensated cirrhosis, and 197 patients were treatment naive before. Seventy-two patients received tenofovir (followed up for 21.4 ± 9.7 mo), 77 patients received entecavir (followed up for 24.0 ± 13.3 mo), and 74 patients received lamivudine (followed up for 36.5 ± 24.1 mo). We collected data on patient demographics and baseline characteristics. Laboratory test results, clinical outcomes, and drug-related adverse events were compared among groups. RESULTS: Levels of HBV DNA less than 400 copies/mL were achieved in 91.5%, 92.5%, and 77% of patients receiving tenofovir, entecavir, or lamivudine, respectively. Levels of alanine aminotransferase normalized in 86.8%, 92.1%, and 71.8% of patients who received tenofovir, entecavir, and lamivudine, respectively. Child-Turcotte-Pugh scores increased among 8.5% of patients who received tenofovir, 15.6% who received entecavir, and 27.4% who received lamivudine. Frequencies of complications from cirrhosis, including hepatic encephalopathy, variceal bleeding, hepatocellular carcinoma, and mortality, were similar among groups. Lamivudine had to be changed to another drug for 32.4% of the patients. CONCLUSIONS: Tenofovir and entecavir are effective and safe for long-term use in patients with compensated or decompensated cirrhosis from HBV infection.

Role of the apparent diffusion coefficient in the differential diagnosis of gastric wall thickening.

PURPOSE: To evaluate the role of the apparent diffusion coefficient (ADC) measurement made using diffusion-weighted magnetic resonance imaging (DWMRI) in the differential diagnosis of benign and malignant gastric wall thickening. MATERIALS AND METHODS: Axial T2-weighted and DWMRI at b 600 and b 1000 s/mm(2) gradients were performed in 94 patients (44 patients with gastric malignancy and 50 patients with benign gastric diseases) with gastric wall thickening which was detected by multidetector computed tomography (MDCT). The ADC values of the gastric lesions and healthy gastric walls in patients with gastric malignancies and in patients with benign gastric diseases were used in the differential diagnosis of benign and malignant lesions of the stomach. RESULTS: The mean ADC values were lower in patients with gastric malignancies (1.62 ± 0.57 and 1.40 ± 0.33 at b 600 and b 1000, respectively) compared to those with healthy gastric walls (2.95 ± 0.59 and 2.18 ± 0.48) and benign gastric diseases (3.08 ± 0.52 and 2.34 ± 0.42) at b 600 and b 1000 gradients (P < 0.0001). CONCLUSION: The ADC measurement on DWMRI may be used to differentiate between benign and malignant gastric diseases.

Prevalence of genotypes in Helicobacter pyloriisolates from patients in eastern Turkey and the association of these genotypes with clinical outcome.

There is not much information available regarding the prevalence of the genotypes of Helicobacter pylori isolates in Turkey, particularly in eastern Turkey. The aims of this study were to detect the prevalence of different genotypes of H. pylori in Turkish patients with gastrointestinal complaints and to determine the relationship of these genotypes with clinical outcome and sex. One hundred forty H. pylori isolates were examined for the presence of its genotypes by the PCR. We found that the prevalence of vacAs1,vacAs2, cagA, cagE, iceA1, iceA2 and babA2 genes were 88.6%, 11.4%, 71.4%, 35.7%, 41.4%, 58.6%, and 62.1%, respectively. The most predominant vacA subtype was s1a (81.4%). The most vacA allelic combination detected were vacAs1m1 (65.2%) and s1m2 (53.9%) in patients with peptic ulcer and gastritis, respectively. The only vacAs1 isolate was significantly associated with gastritis and peptic ulcer (p<0.05). The vacAs1a, ml, slml and babA2 genes were significantly associated with peptic ulcer (p<0.05), whereas m2 gene was significantly associated with only gastritis (p<0.05). The difference between sex and genotypes was statistically significant among the cagA,vacAs1, iceA2 and babA2 genes. This study reported for the first time the prevalence of H. pylori genotypes in patients with gastrointestinal complaints in eastern Turkey. Further studies are needed to understand epidemiological importance of the genotypes of H. pylori isolates in this region and the association between the virulence genes and clinical outcome in different regions.

Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement.

Colorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydinlar and Koç Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.

Successful percutaneous nephrolithotomy in children: multicenter study on current status of its use, efficacy and complications using Clavien classification.

PURPOSE: In this multicenter study we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in children with respect to different features and using the Clavien classification system. MATERIALS AND METHODS: Percutaneous nephrolithotomies performed in children at 3 urology departments between March 2006 and May 2010 were included in the study. Results are presented for complex/simple renal stones, tubeless/totally tubeless percutaneous nephrolithotomy, simultaneous bilateral percutaneous nephrolithotomy, instrument size and age groups. Patients were divided into 3 distinct groups, infants and toddlers (3 years or younger, group 1), preschool children (4 to 7 years, group 2) and school children (8 to 16 years, group 3). Perioperative complications are presented according to the modified Clavien classification system. RESULTS: A total of 140 percutaneous nephrolithotomies were performed in 130 patients (41.5% female, mean age 10.17 years). There were 23, 25 and 92 renal units in groups 1, 2 and 3, respectively. Pediatric instruments were used in 60 renal units and adult-sized instruments in 80. General assessment of complications showed Clavien grade I complications in 17 patients, II in 4, IIIa in 11 and IIIb in 7. There were no grade IV or V complications. CONCLUSIONS: Percutaneous nephrolithotomy can be applied safely in children of varying ages, even infants. Complications, as assessed with Clavien classification, are comparable to those seen in adults provided there is enough experience with the technique.

Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multi-institutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society.

PURPOSE: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. MATERIALS AND METHODS: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. CONCLUSIONS: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.

Tailored treatment approach for emphysematous pyelonephritis.

OBJECTIVE: We evaluated the clinical presentation, diagnosis and management of patients presenting with emphysematous pyelonephritis (EP). PATIENTS AND METHODS: The clinical data of 24 EP patients diagnosed between 2000 and 2009 were retrospectively reviewed. The management strategies were discussed according to the severity of condition at presentation. RESULTS: The mean age of the patients was 61.8 years. Diabetes mellitus was detected in 21 (87.5%) of them. Escherichia coli was the predominant pathogen. There were 6 patients (25%) who recovered with antibiotic treatment only (mild). Percutaneous drainage in addition to antimicrobial chemotherapy was necessary in 13 cases (54%) (moderate). The remaining 5 patients (21%) were treated by nephrectomy (severe). CONCLUSIONS: EP is a serious infection that can display a fatal progression despite ablative treatment but there are also some cases with mild or moderate severity that can be successfully treated without nephrectomy.

Hepatocellular Cancer and Gut Microbiome: Time to Untie Gordian's Knot.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer death worldwide and the incidence is growing on a global scale. About 90% of cases develop on the cirrhotic liver and the etiology is multifactorial. Increasing number of studies suggest that gut microbiota influences the development and progression of liver diseases, including chronic hepatic inflammation, fibrosis, cirrhosis, and HCC. The key role of gut microbiota in carcinogenesis seems to be associated with genomic instability of host cells and immune dysregulation. Recent clinical studies showed that a stable and healthy microbiota initially could have the ability to resist the emergence of chronic inflammation and, therefore, prevent the induction of carcinogenic cells in various organs such as the esophagus, stomach, colon, and liver. The progression from inflammation to cancer is a stepwise process occurring by the concerted action of several factors such as dysbiosis, increased gut permeability, diet, metabolomic, genetic, and epigenetic changes. In this article, we aimed to review the possible role of gut microbiota in the development, progression, and treatment of HCC.

Outcome of percutaneous nephrolithotomy in children having complex stones.

OBJECTIVES: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi. PATIENTS AND METHODS: We retrospectively analyzed the records of 31 children with complex renal calculi who were treated by percutaneous nephrolithotomy at 2 hospitals of our university between June 2003 and June 2008. The mean age of the patients was 10.4 years (range 22 months to 15 years). Three patients were aged < or =5 years. Stone clearance and complications were recorded. RESULTS: The mean operating time (time from insertion of the ureteral catheter to placement of a nephrostomy tube) was 87.4 (range 50-180) min. In 2 patients the procedures were staged because of a large residual stone load. The extent of percutaneous tract dilation was undertaken taking patient age and the presence of hydronephrosis into consideration. Complete stone clearance with percutaneous nephrolithotomy was achieved in 21 (67.7%) of 31 patients. Adding extracorporeal lithotripsy increased total clearance to 24/31 (77.4%). The most common complication was bleeding that necessitated blood transfusion (7/31, 22.5%). CONCLUSION: Percutaneous nephrolithotomy is as safe and effective in children as it is in adults. The clearance rate can be increased with dual therapy. Tract dilation should be tailored according to patient age and the extent of hydronephrosis.

Retroperitoneal fibrosis and obstructive uropathy due to actinomycosis: case report of a treatment approach.

An actinomycotic retroperitoneal infection usually occurs in the presence of an intrauterine device (IUD). It can result in pelvic inflammatory disease and diffuse retroperitoneal fibrosis. A 39-year-old patient was admitted to the emergency unit with left flank pain. A computed tomography scan of the abdomen showed bilateral hydroureteronephrosis and a retroperitoneal malignant mass. Other tumors were excluded with a colonoscopy and an upper gastrointestinal endoscopy. Results of a fine needle aspiration biopsy showed fibrosis compatible with retroperitoneal mesenteritis. Double-J stents were placed in both ureters, and immunosuppressive therapy was started. The patient had clinical and radiologic responses to the therapy. A bilateral ureterolysis and sigmoid colon resection were done. The pathology report showed fibrosis and Actinomyces israelii infection. Parenteral and oral penicillins were administered. The probability of an Actinomyces infection in patients with retroperitoneal fibrosis should be kept in mind, especially in cases in which the patient has an intrauterine device.

Methylenetetrahydrofolate reductase gene polymorphisms in patients with nonalcoholic steatohepatitis (NASH).

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of abnormal hepatic steatosis in the absence of a history of alcohol use. Nonalcoholic steatohepatitis (NASH) is the progressive form of NAFLD. Hyperhomocysteinemia causes steatosis, and the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms result in hyperhomocysteinemia. To examine whether the C677T and A1298C polymorphisms of the MTHFR gene were associated with NASH, we analysed the allele and genotype distribution of the MTHFR C677T and A1298C polymorphisms in 57 well-diagnosed NASH patients, 324 healthy controls in a case-control study of Turkish subjects of Caucasian origin. The diagnosis of the NASH patients was based on liver biopsy. The method used in the analysis of genotypes was PCR-RFLP. The MTHFR A1298C polymorphism was significantly associated with NASH (chi(2) = 8.439; p = 0.015) in the total NASH patients compared with healthy controls. The MTHFR 1298C allele (odds ratio (OR) = 2.480; 95%CI = 1.286-4.782; chi(2) = 7.703; df = 1; p = 0.006) was significantly associated with NASH in the total NASH patients. The MTHFR C677C/A1298C compound genotype (OR = 2.218; 95%CI = 1.003-4.906; chi(2) = 3.998; df = 1; p = 0.046) in men patients was also significantly associated with NASH. Likewise the MTHFR C1298C genotype was significantly associated with NASH in women patients with NASH (OR = 2.979; 95%CI = 1.027-8.641; chi(2) = 4.343; df = 1; p = 0.037). In conclusion, the MTHFR 1298C allele in all NASH patients, C1298C genotype, C677C/C1298C compound genotype in women NASH patients and C677C/A1298C compound genotype in men NASH patients were genetic risk factors for NASH.

Clindamycin-induced acute cholestatic hepatitis.

We report a case of acute hepatotoxicity in a 42-year-old woman after administration of clindamycin for a dental infection. After 6 d of treatment, she had fatigue, nausea, vomiting, anorexia, pruritus and jaundice. Her laboratory analysis showed alanine aminotransferase (ALT), 1795 IU/L (normal range 0-40); aspartate aminotransferase (AST), 1337 IU/L (normal range 5-34); alkaline phosphatase (ALP), 339 IU/L (normal range 40-150); gamma-glutamyl transpeptidase (GGT), 148 IU/L (normal range 9-64 IU/L); total bilirubin, 4.1 mg/dL; direct bilirubin, 2.9 mg/dL and prothrombin time (PT), 13.5 s, with international normalized ratio (INR), 1.04. She was hospitalized, with immediate drug discontinuation. Her liver biopsy specimen showed mixed-type (both hepatocellular and cholestatic) hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that clindamycin was the probable cause of the acute hepatitis. In susceptible individuals, clindamycin use may lead to acute mixed-type liver toxicity. Complete recovery may be possible if the drug is discontinued before severe liver injury is established.

Intrahepatic Cholestasis of Pregnancy: Spontaneous vs in vitro Fertilization.

AIM: Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease in pregnancy. Although it was shown that multiple pregnancy and hormone therapies increase the risk of ICP, there is limited information that compared spontaneous fertilization and in vitro fertilization (IVF) from the aspect of developing ICP. In our study, we investigated the potential relationship between ICP and IVF/ spontaneous pregnancy. MATERIALS AND METHODS: We reviewed the records (between June 2007 and December 2014) of pregnancies with ICP who were referred to gastroenterology clinics in three different hospitals. Fifty-nine pregnancies (43 spontaneous fertilization, 16 IVF) with ICP were analyzed from the aspect of age, fertilization type, multiple/singleton pregnancy, delivery week, and biochemical results. RESULTS: We found that serum bile acid levels were higher in the IVF group than the spontaneous fertilization group (32.8 ± 20 vs 19.6 ± 19 µmol/L; p < 0.05). There was a significant inverse correlation between serum bile acid levels and gestational age (r = -0.42, p < 0.01) in the whole group. There was no difference between IVF and spontaneous fertilization groups in term of age, onset time of symptoms, serum alanine aminotransferase (ALT), alkaline phosphatase (ALP), total and direct bilirubin levels, prothrombin time (PT), international normalized ratio (INR), and platelet count. CONCLUSION: Our results suggest that the serum bile acid levels are higher in IVF than in spontaneous pregnancies with ICP, but its clinical implications are not clear. Further prospective studies with large number of ICP cases are needed to clarify the effect of IVF on ICP.How to cite this article: Bolukbas FF, Bolukbas C, Balaban HY, Aygun C, Ignak S, Ergul E, Yazicioglu M, Ersahin SS. Intrahepatic Cholestasis of Pregnancy: Spontaneous vs in vitro Fertilization. Euroasian J Hepato-Gastroenterol 2017;7(2):126-129.

Endothelial dysfunction in patients with ulcerative colitis.

BACKGROUND: Human intestinal microvessels from chronically inflamed ulcerative colitis (UC) show microvascular endothelial dysfunction. Whether generalized endothelial dysfunction could associate with UC has not been explored yet. Our aim was to assess the endothelial function in the patients with different UC activity and to hypothesize about the relationship of endothelial function to activity-related extraintestinal complications (AREC) of UC. METHODS: Twelve patients with mild UC, 14 patients with moderate UC, 16 patients with severe UC, and 24 healthy subjects were included in the study. The activity of UC is calculated according to the Seo Index. Endothelial functions of the brachial artery were evaluated by using high-resolution vascular ultrasound. Endothelial-dependent dilatation (EDD) was assessed by establishing reactive hyperemia and endothelial-independent dilatation (EID) was determined by using sublingual isosorbide dinitrate. RESULTS: EDD was significantly worse in patients with severe UC as compared with patients with mild UC (8.7 +/- 1.6% versus 17.3 +/- 5.6%, P < 0.05) and even in patients with moderate UC as compared with patients with mild UC (13.1 +/- 3.2% versus 17.3 +/- 5.6%, P < 0.05). EDD was not significantly worse in patients with mild UC as compared with healthy subjects (17.3 +/- 5.6% versus 18.1 +/- 8.1%, P > 0.05). EID was significantly worse in patients with severe UC compared with patients with moderate UC (10.5 +/- 2.9% versus 13.4 +/- 3.7%, P < 0.05) and even in patients with mild UC compared with healthy subjects (20 +/- 6.7% versus 31.1 +/- 12.6%, P < 0.05). EDD and EID were significantly worse in patients with AREC compared with patients with no AREC (9.5 +/- 2.5% versus 14.9 +/- 5.1%, P < 0.05; 11.6 +/- 4.3% versus 16 +/- 6.1%, P < 0.05, respectively). CONCLUSIONS: Increased activity of UC is associated with significant endothelial dysfunction, which may relate to the pathophysiology of AREC of UC.

Serum levels of hepatoprotective peptide adiponectin in non-alcoholic fatty liver disease.

OBJECTIVE: Adiponectin is an adipose tissue-specific protein that has anti-inflammatory, antidiabetic and antiobesity effects. It has been suggested that adiponectin has a hepatoprotective role. Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent with increasingly adverse clinical outcomes. In this study, serum adiponectin levels were investigated in patients with NAFLD to determine its possible role on hepatic inflammation and injury. METHODS: Twenty-nine biopsy-proven NAFLD patients (14 women, 15 men) with elevated liver enzymes, 20 clinically diagnosed NAFLD patients (13 women, seven men) with normal liver enzymes, and 20 healthy adults (10 women, 10 men) were enrolled. From fasting blood samples, serum adiponectin levels were measured by enzyme-linked immunosorbent assay. The body mass index, serum glucose, insulin, cholesterol and triglyceride levels were determined. RESULTS: Serum adiponectin levels were 4.99+/-2.1, 9.49+/-3.91 and 7.74+/-4.41 micro/ml in the NAFLD with elevated liver enzymes, NAFLD with normal liver enzymes and healthy adult control groups, respectively. The mean serum adiponectin level in the NAFLD with elevated liver enzymes group was significantly lower than those of other groups tested (P<0.001). Insulin, cholesterol and triglyceride levels of NAFLD patients with elevated liver enzymes were significantly higher than control groups (P<0.05) but were not significantly different from the NAFLD group with normal liver enzymes (P>0.05). On histopathologic examination, the mean serum adiponectin levels of non-alcoholic steatohepatitis patients with grade 2 or more inflammatory activity was significantly lower than patients with grade 1 inflammatory activity (P=0.013). CONCLUSION: Serum adiponectin levels are significantly lower in NAFLD patients with elevated liver enzymes. Non-alcoholic steatohepatitis patients show lower levels of adiponectin with higher grades of inflammation.

The value of serum mean platelet volume in testicular torsion.

OBJECTIVE: To compare the serum mean platelet volume (MPV) in patients with testicular torsion and healthy control subjects. METHODS: This retrospective study compared clinical and demographic data from patients who underwent surgery for testicular torsion and healthy controls. Testicular torsion was diagnosed with a physical examination and Doppler ultrasonography. Age, leukocyte count, platelet count and MPV were recorded for all participants. RESULTS: A total of 50 patients with testicular torsion and 51 healthy control subjects were enrolled. There was no significant difference in age and platelet count between the two groups. Patients with testicular torsion had a significantly higher leukocyte count and MPV, compared with controls. According to receiver operating characteristic curve analysis performed for the prediction of testicular torsion, the best cut-off point for MPV was 7.7 fl (sensitivity 62%, specificity 96%), and the best cut-off point for leukocyte count was 9.5 × 10(9)/l (sensitivity 58%, specificity 80%). CONCLUSIONS: The MPV may be useful as an ancillary test for the diagnosis of testicular torsion. Further studies are needed in order to confirm these preliminary results.

Genetic variants in the PNPLA3 gene are associated with nonalcoholic steatohepatitis.

In this study, we report the association of the rs738407, rs738409, and rs2896019 variants of the patatin-like phospholipase domain-containing protein 3 (PNPLA3) (adiponutrin) gene with nonalcoholic steatohepatitis (NASH) (χ(2)=14.528, p=0.001; χ(2)=18.882, p=0.000; χ(2)=7.449, p=0.024, respectively) in 80 patients with NASH and 303 healthy controls. We genotyped the subjects using three polymerase chain reaction-restriction fragment length polymorphism methods developed in our laboratory. Our findings confirm the findings of the recent case-control and genome-wide association studies carried out in different populations around the world. Thus, the three variants in PNPLA3 gene may be a genetic risk factor for NASH.