Comparison of the effectiveness of i-scan and conventional endoscopy in the detection of the endoscopic signs of atrophic gastritis: A clinical trial.

BACKGROUND AND STUDY AIMS: This study aimed to determine whether the use of i-scan endoscopy provides additional benefits to conventional endoscopy in the diagnosis of gastric precancerous lesions. PATIENTS AND METHODS: A total of 120 patients with histologically-verified intestinal metaplasia (IM) or atrophic gastritis (AG) were prospectively evaluated by esophagogastroduodenoscopy. Endoscopic examinations were performed using i-scan and high-definition white-light endoscopy (HD-WLE). The diagnostic yields of both techniques and the number of targeted biopsies per patient were compared. RESULTS: A total of 318 suspicious lesions were detected in 108 patients with i-scan (n = 186) and 81 patients with HD-WLE (n = 132). The diagnostic yields of i-scan and HD-WLE were 81.6% (98/120) versus 77.5% (93/120), respectively (p > 0.05). When only targeted biopsies were taken into account, the diagnostic yields of i-scan and HD-WLE were 89.8% versus 65.4%, respectively (p < 0.05). The mean number of biopsies per patient for i-scan and HD-WLE were 3.27 (393/120) and 7.3 (882/120), respectively (p < 0.05). The mean endoscopic procedure times were 16 and 17 min for i-scan and HD-WLE, respectively (p > 0.05). CONCLUSIONS: Although targeted biopsies with i-scan were not found to be significantly superior to either targeted or random biopsies with HD-WLE, the number of biopsies required to confirm these lesions was much lower.

Colorectal stenting for palliation and as a bridge to surgery: A 5-year follow-up study.

AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction. METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients' symptoms, characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate (TSR) was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate (CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery (regardless of number of SEMS deployed) to total number of patients. The surgical success rate (SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical, clinical, surgical success rates and complications after stenting were assessed. RESULTS: The median age of patients was 64 (36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum, 15 patients in the rectosigmoid region, 10 patients in the sigmoid region, and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2 (32.7%, 16 patients) or stage 3 (42.9%, 21 patients) and 12 patients (24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery, and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo (P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies, especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical, clinical and surgical success rates were 95.9%, 100% and 94.6%, respectively. CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition, results emphasize the importance of the skills of the endoscopist in colonic stenting.

Iloprost reduces colitis induced oxidative stress: An experimental study in rats.

BACKGROUND/AIMS: Reactive oxygen species have a known potent role in the pathogenesis of ulcerative colitis. Iloprost, a pharmaceutical, is a chemically stable derivative of a naturally- occurring human prostacyclin. Several studies have demonstrated protective effects of iloprost via its antioxidant and its anti-inflammatory activity. The aim of this study is to evaluate the effects of iloprost on oxidant/antioxidant status, as well as the large bowel histopathology in experimental colitis. MATERIALS AND METHOD: Forty adult male Wistar-albino rats were randomly divided in to four equal weight-matched groups: sham group (n=10), iloprost administered sham group (n=10), colitis group (n=10), iloprost administered colitis group (n=10). Acetic acid (1 ml of 4% solution) was used to induce colonic inflammation in the rats. RESULTS: Colonic tissue and plasma malondialdehyde levels were significantly lower in the iloprost administered colitis group than the colitis group (p<0.01). Tissue glutathione levels of the iloprost administered colitis group were significantly higher than the colitis group (p<0.001). CONCLUSION: We have demonstrated in this study iloprost to be an antioxidant, as well as iloprost demonstrating protective activity against colitis induced oxidative stress.

Herbal haemorrhoidal cream for haemorrhoids.

Although hemorrhoids are one of the most common diseases in the world, the exact etiology underlying the development of hemorrhoids is not clear. Many different ointments are currently used to treat hemorrhoids; however, there is little evidence of the efficacy of these treatments to support their use. The aim of this study was to compare different herbal creams used for the treatment of hemorrhoids. Twenty-eight male Wistar albino rats, 6-8 weeks old and weighing 160-180 g, were used in this study as 1-control, 2-croton oil, 3-croton oil+fig leaves+artichoke leaves+walnut husks and 4-croton oil+fig leaves+artichoke leaves+walnut husks+horse chestnut fruit. After 3 days of croton oil application, rats were treated with 0.1 ml of cream or saline twice a day for 15 days by syringe. Tissue and blood samples were collected for histological, immunohistochemical and biochemical studies. Statistical significance was determined using one-way ANOVA followed by Tukey's multiple comparison tests. Croton oil administration resulted in severe inflammation. The third group showed partial improvement in inflammation; however, the greatest degree of improvement was seen in the fourth group, and some recovered areas were observed. Myeloperoxidase immunoreactivity was found to be decreased in the third and fourth groups compared to the second group. Additionally, biochemical analyses (Myeloperoxidase, Malondyaldehyde, nitrate/nitrite and nitrotyrosine levels and Superoxide Dismutase activity) were in agreement with the histological and immunohistochemical results. In conclusion, croton oil causes inflammation in the anal area and results in hemorrhoids. Treatment with our herbal hemorrhoid creams demonstrated anti-inflammatory and anti-oxidant effects in this model.

Covered self-expandable metallic stents could be used successfully in the palliation of malignant cervical esophageal strictures: preliminary report.

PURPOSE: To present the authors' preliminary experience with covered self-expandable metallic stents in the palliation of malignant cervical esophageal strictures. METHODS: Covered self-expandable metallic stents were placed into the cervical esophagus of 6 patients with malignant cervical esophageal strictures under fluoroscopic guidance. RESULTS: Stent placement was technically successful in all patients, and the mean dysphagia score decreased from 3.3 to 0.5 according to the Ogilvie Dysphagia Scoring. Two patients complained of chest pain, which lasted for 24 to 48 hours. Foreign body sensation disappeared spontaneously within a week in all patients, but one. Migration, dysphagia, or obstruction was not observed in any of the patients during the follow-up period (47 d to 8 mo). CONCLUSIONS: According to our limited number of cases, placement of covered self-expandable metallic stents into the cervical esophagus can be performed safely, and significant improvement of dysphagia scores and life quality of patients can be obtained instantly after the procedure.

A rare complication of jejunostomy tube: Enteral migration.

Feeding jejunal tubes provide an excellent method for enteral nutritional support in cases where the oral route is impossible or insufficient for use. However, several complications may result from the placement of the tube. Detachment of the tube and migration through the intestine is a very rare complication. We report herein a 65-year-old male patient in whom a jejunal feeding tube (28-F Pezzer catheter) was placed two months before due to unresectable gastric cancer. He presented with disappearance of the tube and abdominal pain. Radiological investigations showed the tube localized in the lumen of the small intestine and its advancement through the gut. Conservative measures were taken as there was neither intestinal obstruction nor peritonitis. The tube passed spontaneously through the rectum 18 days later. One should be careful during the placement of jejunostomy tubes, and health care providers and patients should be instructed well in the care of feeding enterostomy tubes in order to prevent this complication.

The role of dura mater and free peritoneal graft in the reinforcement of colon anastomosis.

Anastomotic leakage is the most important complication leading to morbidity and mortality in colorectal surgery. To prevent anastomotic leakage, a number of drugs with different mechanisms of action were tested, and autogenic grafts and various synthetic materials were used for reinforcement of the anastomotic region. In this experimental study aimed at preventing anastomotic leakage and dehiscence, we used dehydrated, lyophilized human dura mater and free peritoneal graft for reinforcement of anastomotic region after primary repair in rats, and investigated whether they are superior to primary anastomosis. The rats were sacrificed 3 and 7 days postoperatively. The anastomotic region was observed macroscopically for adhesions, bursting pressure of bowel was measured for tensile strength of the anastomosis, and histopathologic evaluation was performed for anastomotic healing. Compared to the control group, dura mater and free peritoneal graft groups displayed a lower bowel bursting pressure (p < .05), worse anastomotic healing (p < .05), a higher number of adhesions, and presence of anastomotic stricture. In conclusion, both human dura mater and free peritoneal graft reinforcement groups had worse anastomosis healing. The results could be attributed to avascularity of grafts and to aggravated adhesions between anastomosis and intra-abdominal organs, which created a favorable environment for reproduction and dispersion of bacteria and consequently led to decreased anastomosis healing.

Prognostic significances of oxidative DNA damage evaluated by 8-hydroxy-deoxyguanosine and antioxidant enzymes in patients undergoing resection of gastric and colon carcinoma.

Oxidant/antioxidant balance has been suggested as an important factor for initiation and progression of cancer. In order to determine whether the degree of oxidative DNA damage and antioxidant enzyme activities in plasma obtained from patients with gastric and colon cancer who undergo resection can be used as a useful prognostic predictor, plasma level of 8-hydroxydeoxyguanosine (8-OHdG), activities of glutathione peroxidase (G-Px) and superoxide dismutase (SOD) were examined. 19 patients with gastric cancer and 26 patients with colon cancer who were undergoing resection of tumor were included by the study. Venous blood samples were taken just before the surgery. Plasma level of 8-OHdG was determined with ELISA, SOD and G-Px activities in plasma were measured by spectrophotometric kits. 8-OHdG level and activity of G-Px were found to be decreased, SOD activity was found to be increased in both gastric and colon cancer groups as compared to control group. Alpha fetoprotein was found to be correlated with G-Px in the gastric cancer group and correlated with 8-OHdG in the colon cancer group. SOD activity was correlated with CA-15-3 in the gastric cancer group. Low plasma level of 8-OHdG and altered antioxidant activity may implicate the deficient repair of oxidative DNA damage in patients with gastric and colon cancer. Those measured parameters were not found to be related with histopathological data but correlated with some tumor markers.

Nitric oxide and antioxidant defense in patients with gastric cancer.

In the present study, total nitrate and nitrite level (as end product of nitric oxide), superoxide dismutase activity, and glutathione peroxidase activity in leukocytes were determined in patients with gastric cancer, and the relationship between measured parameters and tumor grade were evaluated. Leukocyte nitrate and nitrite level was found to be increased and superoxide dismutase activity was found to be decreased in patients compared to controls. When the patient group was categorized, nitrate and nitrite level was found to be higher in patients with a high-grade tumor than in patients with a grade I tumor. We concluded that an increased level of leukocyte nitrate and nitrite is related to tumor grade in patients with gastric cancer; antioxidant activity is also impaired in these patients but it does not seem to be related to grade of tumor.

Oxidative stress and nitric oxide in rats with alcohol-induced acute pancreatitis.

AIM: Oxygen free radical mediated tissue damage is well established in pathogenesis of acute pancreatitis (AP). Whether nitric oxide (NO) plays a deleterious or a protective role is unknown. In alcohol-induced AP, we studied NO, lipooxidative damage and glutathione in pancreas, lung and circulation. METHODS: AP was induced in rats (n = 25) by injection of ethyl alcohol into the common biliary duct. A sham laparatomy was performed in controls (n = 15). After 24 h the animals were killed, blood and tissue sampling were done. RESULTS: Histopathologic evidence confirmed the development of AP. Marked changes were observed in the pulmonary tissue. Compared with controls, the AP group displayed higher values for NO metabolites in pancreas and lungs, and thiobarbituric acid reactive substances in circulation. Glutathione was lower in pancreas and in circulation. Glutathione and NO were positively correlated in pancreas and lungs of controls but negatively correlated in circulation of experimental group. In the experimental group, plasma thiobarbituric acid reactive substances were negatively correlated with pancreas thiobarbituric acid reactive substances but positively correlated with pancreas NO. CONCLUSION: NO increases in both pancreas and lungs in AP and NO contributes to the pathogenesis of AP under oxidative stress.

Evaluation of O6-methylguanine DNA methyltransferase activity in patients with gastric cancer.

O6-Methylguanine DNA methyltransferase (O6-MGMT) reverses DNA alkylation damage produced alkylating agents. O6-MGMT is also a major determinant of cellular resistance to adjuvant chemotherapy with alkylating drugs. O6-MGMT activity was measured in samples from patients with gastric cancer, including tumor, adjacent normal appearing mucosa, and peripheral blood leukocytes (PBL). O6-MGMT activity of PBL from healthy individuals was evaluated as control. There was no significant difference between controls and patients for O6-MGMT activity in PBL. O6-MGMT activity was significantly increased in tumor tissue. Tumor O6-MGMT activity was found to be independent from tumor subgroups and tumor grade. A positive correlation was determined between O6-MGMT activity in tumor and in circulating PBL. The results indicate that O6-MGMT, a defense protein against alkylating agent-mediated carcinogenesis, increased in gastric tumors. This may explain the low response rate to drug combinations, including chloroethylnitrosoureas, exhibited by patients with gastric cancer.