Acute toxic hepatitis induced by a herbal medicine : Anchusa Boraginaceae.

BACKGROUND AND AIM: Herbal treatments are becoming increasingly popular in many countries. Anchusa Boraginaceae (also called Tort plant and beef tongue) is commonly used as a herbal medicine in Elazig region as diuretic and in the treatment of ulcers, and it is stated that this has no adverse effect. We report a case of acute hepatitis associated with long time use of high doses of Anchusa Boraginaceae. CASE: A 43-year-old male patient is drinking water of Anchusa Boraginaceae that is boiling for 14 days to dissolve the stones in the gallbladder. He had no medical history and did not take any other drugs or toxins. Two weeks later ; he admitted with developed tea colored like urine and yellowing of the body. Three weeks later; he was referred to the our department from the epicenter. Blood tests showed aspartate aminotransferase : 37 U/L, alanine aminotransferase : 66 U/L, gama glutamyl transferase : 23 U/L, total bilirubin : 16.9 mg/dL, direct bilirubin : 12 mg/dL, and INR : 1.3 Viral and autoimmune hepatitis were eliminated. Upper abdominal ultrasound was normal. After the herbal medicine was stopped on admission, the patient's laboratory tests didn't recover. Then; the support treatment was performed. The clinical and the laboratory values returned to normal after 2 months after the acute episode. CONCLUSIONS: The consumption of herbal medicines containing Anchusa Boraginaceae can induce toxic hepatitis. Recovery can be complete after discontinuation. This case report highlights the risk and lytic effect on gallstone associated with Anchusa Boraginaceae.

The role of the eNOS G894T and T-786C gene polymorphism in the development of ascites in cirrhosis.

OBJECTIVE: Increased nitric oxide (NO) production in cirrhotic patients causes splanchnic vasodilation, leading to the development of the hyperdynamic circulatory syndrome. One factor that influences plasma NO concentration is eNOS gene polymorphism; consequently, the aim of this study was to investigate whether the eNOS gene G894T and T-786C polymorphisms play any role in the development of ascites in such patients. PATIENTS AND METHODS: Three groups were created: 70 cirrhotic patients with ascites, 69 cirrhotic participants without ascites (stable cirrhosis), and 60 healthy controls. Polymorphisms were determined using polymerase chain reaction (PCR) and melting curve analysis. The plasma nitrite (NO marker) level was measured by deploying the spectrophotometric Griess reaction. RESULTS: Plasma nitrite levels in the cirrhosis with ascites and stable cirrhosis groups were significantly higher than in the controls (p < 0.0001). The frequency of GG, GT, and TT genotypes for the eNOS G894T polymorphism in the cirrhosis with ascites group was 55.7%, 38.6%, and 5.7% respectively, while in the stable cirrhosis group these figures were 60.9%, 36.2%, and 2.9%. In the controls, the distribution was 63.3%, 33.3%, and 3.3%, respectively. The frequency of TT, TC, and CC genotypes for the eNOS-786C polymorphism in the first group was 52.9%, 34.2%, and 12.9% respectively; in the second group, this was 46.4%, 42%, and 11.6%, and in the controls, 48.3%, 46.7%, and 5%. There were no significant differences in genotype and allele distributions of the eNOS-786C and eNOS G894T polymorphisms among the groups. CONCLUSIONS: Plasma nitrite concentration is enhanced in cirrhotic patients, and there is no relationship between the G894T and eNOS-786C polymorphisms and the development of ascites.

Familial alpha 1 antitrypsin deficiency cases that are diagnosed in adulthood.

Alpha 1 antitrypsin (AAT) deficiency is a hereditary disorder leading to severe lung and liver diseases worldwide. An accumulation of insoluble heterodimer AAT molecules in hepatocytes is the main cause of liver disorders. The most commonly detected allele worldwide is the PIMM allele, which fulfills the AAT function. The most common missing variant is PiZZ. Serum AAT level is a beneficial but not a reliable determinant for diagnosis. Liver biopsy yields more reliable results. AAT deficiency has no specific treatment. The only treatment modality in children with end stage liver disease is the hepatic transplant. We wanted to present in our article four cases from same family, diagnosed alpha-1 antitrypsindeficiency in adulthood.

The protective effects of apocynin on ionizing radiation-induced intestinal damage in rats.

BACKGROUND AND AIMS: Radiation colitis typically emerges during radiotherapy of intra-abdominal malignancies. While the underlying mechanism remains unclear, it is considered that free oxygen radicals act like cellular mediators to cause colonic damage. Apocynin (APO) prevents oxidative stress and apoptotic cell death by inhibiting NADPH oxidase, and preventing the formation of free oxygen radicals. The aim of the present study was to investigate the protective effect of APO, a strong antioxidant and antiinflammatory agent, on radiation induced colonic oxidative damage in rats. MATERIALS AND METHODS: Rats were randomly divided into four groups (n = 8/group). Group I (control group); Group II (Group RAD) received a single dose of 800 cGy ionizing radiation to the whole abdomen with a linear accelerator (LINAC); Group III (Group APO) received a single dose of 20 mg/kg of APO intraperitoneally for five days; Group IV (Group APO+RAD) received APO for five days before radiation exposure (similar to Group III), (similar to Group II). RESULTS: APO treatment prior to radiation led to protection in the biochemical and histopathological parameters. CONCLUSIONS: Our study shows that APO treatment before radiation improves radiation induced colonic injury in rats, by decreasing oxidative stress and apoptosis.

Relationship of percutaneous endoscopic gastrostomy-related mortality and morbidity rates and effectiveness with advancing age.

BACKGROUND AND AIMS: Percutaneous endoscopic gastrostomy (PEG) is insertion of a tube to stomach through abdominal wall for provision of nutrition in patients who couldn't be fed by oral route. In the present study, it was aimed to evaluate PEG procedures performed in our facility regarding indication, complication and effectiveness and to determine whether these characteristics have a relationship with advancing age. MATERIAL AND METHODS: In this descriptive study, we reviewed clinical and endoscopic records of 300 patients who underwent PEG procedure between May 2009 and December 2011. The patients were divided into 2 groups(group 1 > 75, group 2 < 75 years). All patients were retrospectively reviewed regarding demographic data, indications, biochemical parameters (Hemoglobin, total protein and albumin) at baseline and 3 months after procedure, complications and mortality. RESULTS: The most common indication for PEG was neurological (67.3%). Wound infection (6.0%) was most common early complication while tube occlusion (4.7%) was most common late complication. No significant difference was detected between groups regarding morbidity and mortality (p < 0.05). It was seen that there were significant improvement in all biochemical parameters (p < 0.001). The most significant improvement was observed in total protein values (p < 0.05). However, no significant difference was detected in individual parameters (p > 0.05). CONCLUSIONS: PEG should be preferred at early period in patients who couldn't be fed by oral route for prolonged time as it is a minimally invasive, simple, inexpensive, highly effective, physiologic and safe. PEG was found to have no relationship with advancing age regarding indications, morbidity, mortality rate and effectiveness.

Ecstasy induced acute hepatic failure. Case reports.

3,4-methylenedioxymethamphetamine (MDMA), an amphetamine derivative known as ecstasy, has stimulating and hallucinogenic properties. It has become a substance that is widely used especially by young people. Hepatotoxicity is one of the rare side effects of this substance and can be fatal. Ecstasy-induced fulminant hepatitis has been reported in case reports. The clinical course and the prognosis of the cases may differ. In this article, two cases in whom ecstasy-induced fulminant hepatic failure had developed and who were treated with liver transplantation, and one case which recovered with treatment, have been presented.