Myeloperoxidase and calprotectin; Any role as non-invasive markers for the prediction of inflammation and fibrosis in non-alcoholic steatohepatitis?

BACKGROUND/AIMS: Specific serum markers reflecting hepatic inflammation and fibrosis are required to tailor the treatment strategies in non-alcoholic steatohepatitis (NASH). We aimed to investigate the roles of myeloperoxidase (MPO) and calprotectin in predicting the hepatic inflammation status and disease severity in NASH. MATERIALS AND METHODS: A total of 48 patients with biopsy-proven NASH and 25 healthy volunteers with normal weight were prospectively enrolled. Serum MPO and calprotectin levels were compared between the NASH and control groups. Hepatic MPO and calprotectin expressions were compared in terms of histologic non-alcoholic fatty liver disease activity scores (NAS) (low NAS [≤4] vs. high NAS [>5]) and fibrosis stage (insignificant [F0-1]/significant [F2-4]). RESULTS: Serum MPO and calprotectin levels were not significantly different between the NASH and control groups. In the subgroup analysis, hepatic MPO expression was significantly increased in patients with NASH with significant fibrosis than in those with insignificant fibrosis (F2-4: 7.04±3.61 vs. F0-1: 4.83±2.42, p=0.01). We found no difference between the groups with low and high NAS with regard to serum MPO and calprotectin levels and hepatic MPO and calprotectin expressions. CONCLUSION: This study demonstrated that hepatic MPO expression can reflect advanced fibrosis in NASH. However, when serum MPO and calprotectin levels were evaluated as potential serum markers, both did not associate with hepatic inflammation status and fibrosis stage in NASH. Therefore, our study results preclude their use as serum markers for hepatic inflammation in NASH.

Idiopathic weight loss due to an entero-enteric fistula from a gossypiboma retained for 27 years.

Gossypiboma refers to a mass formed around surgical instruments or materials left in the body postoperatively. The occurrence of gossypibomas remains an important problem, despite improvements in surgical procedures and operating room facilities. The clinical presentation of gossypiboma can vary depending on the host response. This report describes a case of abdominal gossypiboma after splenectomy. A 48-year-old man who had undergone splenectomy 27 years ago was admitted to our clinic suffering from non-specific symptoms for 2 weeks. He was cachectic, but laboratory test results were normal. Abdominal ultrasonography and computed tomography revealed a mass in the left hypochondrium. An entero-enteric fistula and an encapsulated foreign body (surgical compress) were detected during an exploratory laparotomy, and the foreign body was removed. Preventing gossypibomas is very important because of their potential to create medico-legal problems and increase mortality and morbidity. Therefore, forgotten surgical material should be considered in all patients with a surgical history, and surgery should be performed carefully.

Nonalcoholic Fatty Liver Disease is Associated with Erectile Dysfunction: A Prospective Pilot Study.

INTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome (MetS). Although the link between MetS and erectile dysfunction (ED) is well known, clinical studies investigating the association between NAFLD and ED are scant. AIM: To evaluate the relationship between NAFLD and ED. METHODS: Male patients with biopsy-proven NAFLD were prospectively asked to fill the five-item International Index of Erectile Function (IIEF-5) questionnaire. Their clinical and histologic variables were compared with the IEFF scores. MAIN OUTCOME MEASURES: IIEF scores; proportions of NAFLD patients who demonstrated ED and/or MetS; association between the severity of histological hepatic damage and ED. RESULTS: Forty male patients having an age range of 33 (24-57) and a mean age of 40.13 ± 10.22 years with biopsy-proven NAFLD had a median IIEF-5 score of 16 (9-25) and MetS was present in 23 (57.5%). ED severity distributions as moderate, mild, and no ED were 11 (27.5%), 16 (40%), and 13 (32.5 %), respectively. Histological NAFLD score was significantly higher in patients having ED compared with patients with no ED (5.63 ± 1.39 vs. 4.15 ± 1.46; P = .006). MetS diagnosis was significantly more common in patients having ED, compared with those without ED [19 (70.4%) vs. 4 (30.8%), respectively, P = .018)]. When patients with and without ED were compared, gamma glutamyl transferase was significantly lower in ED, whereas components of MetS did not correlate with ED. After multivariate analysis, NAFLD score has remained the only significant outcome associated with ED [P = .03; OR (95% CI): 2.38 (1.079-5.238)]. CONCLUSION: The current clinical study demonstrates a significant association between nonalcoholic steatohepatitis and ED for the first time. Our findings suggest liver damage may play role in the pathogenesis of ED in patients with NAFLD. Future studies are needed to expand the underlying common mechanisms responsible for this novel hypothesis.

Is the neutrophil-to-lymphocyte ratio a potential diagnostic marker for peptic ulcer perforation? A retrospective cohort study.

OBJECTIVES: Peptic ulcer perforation (PUP) accounts for 5% of all abdominal emergencies and is recognized as a gastrointestinal emergency requiring rapid and efficient clinical evaluation and treatment. The mortality rate ranges from 10% to 40% among patients with perforation. In the present retrospective study, we examined the potential utility of the neutrophil-to-lymphocyte ratio (NLR) in early diagnosis of PUP; we asked whether this ratio allowed PUP and peptic ulcer disease to be distinguished. METHODS: We enrolled the following patients: 58 with PUP, 62 with noncomplicated peptic ulcer diseases (NCPU), and 62 controls, between May 2010 and 2015. Patients who underwent surgical repair to treat PUP were included in the study group. Another group consisted of NCPU patients who had a noncomplicated peptic ulcer. The control group consisted of patients presenting with nonspecific abdominal pain to the emergency department. RESULTS: The mortality rate was 5.2% in the PUP group. The white blood cell count, C-reactive protein, and NLRs were higher in the PUP compared to the other groups (P<.001 for all). The white blood cell count and NLR did not differ between the NCPU and control groups. The sensitivities, specificities, positive predictive values, and negative predictive values of the NLRs were 68.0%, 88.0%, 82.9%, and 72.9%, respectively. CONCLUSIONS: We suggest that preoperative NLR aids in the diagnosis of PUP and can be used to distinguish this condition from peptic ulcer disease. Thus, the NLR should be calculated in addition to the clinical examination.

Hypertensive retinopathy: incidence, risk factors, and comorbidities.

We aimed to determine the prevalence and risk factors of retinopathy in hypertensive outpatients. Demographic data, accompanying diseases, anthropometric measurements, and blood and urine biochemistry of 655 hypertensive patients were evaluated. Hypertensive retinopathy rate was 66.3% (grade 1, 33.6%; grade 2, 32.7%). Age, duration of hypertension, and systolic blood pressure levels were significant risk factors for retinopathy (P = .048, P = .035, and P = .012, respectively). Any correlations between retinopathy and gender, body mass index, biochemistry, and associated diseases were not found. This study shows that the degree and duration of hypertension increases the incidence of retinopathy. Low-grade retinopathy seems not to be associated with other cardiovascular risks.

Association of clinical and pathological variables with survival in thymoma.

Our aim was to evaluate clinical and pathological features in prognosis of thymoma patients with particular emphasis on patients with myasthenia gravis (MG). From 1995 to 2010, 140 thymoma patients (women/men: 63/77) with a median age of 46 years (11-80 years) were admitted to our institution. According to World Health Organization (WHO), there were 23 (17%) type A, 12 (9%) type AB, 24 (17%) type B1, 42 (31%) type B2 and 36 (26%) type B3. The distribution of Masaoka stages I, II, III and IV was 24 (17%), 71 (51%), 18 (13%) and 27 (19%), respectively. MG coexisted in 61% of patients. After a mean follow-up of 34 months (1-158 months), 102 (73%) patients are alive and well while 14 (10%) are alive with disease. Twenty-three patients (16%) have died, only 9 died of thymoma. In univariate analyses, completeness of resection (P < .001), WHO histology (P = .008), Masaoka stage (P < .001) and MG (P = .002) were significant prognostic factors for progression-free survival (PFS). Young age (P = .008); Masaoka stages 1 and 2 (P = .039); WHO types A, AB and B1 (P = .031); complete resection (P = .024) and presence of MG (P = .05) significantly correlated with overall survival (OS). In multivariate analysis, Masaoka stages 1 and 2 (P = .038) and presence of MG (P = .01) were significantly correlated with a longer PFS; MG (P = .021) and WHO subtype (P = .022) were found to be significant prognostic factors for OS. Adjuvant radiotherapy improved neither OS nor PFS in completely resected stage 2 thymoma. Masaoka staging, WHO and MG are major determinants of prognosis in Turkish thymoma patients. Additionally, radiotherapy did not provide survival advantage to stage 2 patients with complete resection.