Primary aortoduodenal fistula due to a swallowed sewing needle: a rare cause of gastrointestinal bleeding.

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Atherosclerosis remains the most common etiologic factor, accounting for more than two-thirds of the cases reported. Other etiologies include carcinoma, ulcers, radiation, aortitis and foreign bodies including sewing needle, cocktail stick, open safety pin and fishbone. We report a case of a 17 year-old girl who underwent surgical treatment because of severe upper gastrointestinal bleeding which was related to an aortoduodenal fistula caused by a swallowed sewing needle. At operation, a chronic aortoduodenal fistula that contained the sewing needle was found and repaired. This is the fourth case in the literature in which a needle was found to be associated with the development of an aortoenteric fistula.

Chronic hepatitis delta virus infection in Van region of eastern Turkey.

BACKGROUND/AIMS: Hepatitis delta virus infection is an important cause of liver morbidity and mortality worldwide. In Eastern Turkey, hepatitis B virus infection is the major cause of chronic liver diseases. We aimed to research the role of hepatitis delta virus infection in chronic liver diseases related to hepatitis B virus infection in the Van region of Eastern Turkey. METHODS: Serological markers of hepatitis B virus and hepatitis delta virus infection [HBsAg, HbeAg, Anti-HBe and Anti- hepatitis delta virus total (IgM+IgG)] were determined by ELISA test in patients with chronic hepatitis and cirrhosis. Serum hepatitis B virus DNA was determined by polymerase chain reaction (PCR) method in chronic hepatitis B patients. RESULTS: Hepatitis delta virus infection was detected in 5% (7/138) of asymptomatic hepatitis B virus carriers, in 16% (24/148) of chronic hepatitis B patients and in 45% (34/75) of cirrhotic hepatitis B virus patients. hepatitis delta virus infection showed a three-fold increase in chronic hepatitis (p<0.01) and nine-fold increase in cirrhosis (p<0.001) compared to hepatitis delta virus carriers. Also, it was three times more frequent in cirrhosis (p<0.001) compared to chronic hepatitis. Chronic hepatitis delta virus infection was equally distributed between sexes in patients with chronic hepatitis B virus infection, whereas chronic hepatitis B virus infection alone was three times more frequent in males (p<0.001). Mean ages of hepatitis delta virus carriers, chronic hepatitis D and hepatitis delta virus cirrhosis patients were 30.7+/-8 (14-65), 36+/-13 (19-70) and 44 +/-16 (25-55), respectively. CONCLUSIONS: The higher prevalence of hepatitis delta virus infection in more severe form of hepatitis B virus infection suggests that hepatitis delta virus infection increases the severity of chronic hepatitis B virus infection in the Van region. hepatitis delta virus infection remains a second major cause of chronic liver diseases in Eastern Turkey in spite of its decreasing prevalence in Western countries and in Western Turkey.

Epidemiological aspects of endemic upper gastrointestinal cancers in eastern Turkey.

BACKGROUND/AIMS: The aim of our study was to present the epidemiological aspects of endemic upper gastrointestinal (esophageal and gastric) cancers in the Van region of Eastern Turkey. METHODOLOGY: The patients were diagnosed by esophagogastroscopy, biopsy and histopathological analysis. The control group consisted of 73 healthy subjects. Epidemiological characteristics (age, sex, dietary habits, educational status, life style) were evaluated by questionnaires. Helicobacter pylori infection was diagnosed in nontumoral gastric mucosal biopsy specimens by Giemsa staining. RESULTS: 298 esophageal Ca and 384 gastric Ca patients were diagnosed in seven years (1994-2001). Most of the patients (90%) were of rural origin. Endoscopic prevalence rate of upper gastrointestinal (UGI) Ca was the highest (1 Ca per 7 esophagogastroscopy) in the Van region compared to other parts of Turkey. Esophageal Ca were 1.5 times more common in females whereas gastric Ca were 1.6 times more common in males. Ninety per cent of esophageal cancers were epidermoid and the remaining 10% were adenocarcinomas. Ninety-seven per cent of gastric Ca were adenocarcinomas. Helicobacter pylori infection was not significantly increased in gastric Ca patients compared to controls. CONCLUSIONS: Low educational and socioeconomic status, consumption of smoked, salted, hot, fatty foods, overdrinking hot tea and well water, cigarette smoking, poor intake of fresh fruits and vegetables and poor hygienic conditions were probable culprit factors.

The association of short segment Barrett's esophagus with intestinal metaplasia in stomach.

BACKGROUND/AIMS: The aims of this study were to investigate the presence of short segment Barrett's esophagus in people found to have tongue-like columnar mucosal protrusions in the distal esophagus and to determine the relationship between short segment Barrert's esophagus and Helicobacter pylori, gastritis and intestinal metaplasia observed in other parts of the stomach. METHODS: The study included 50 patients (32 male, 18 female). Two biopsy specimens were taken from the antrum, at least 2 cm away from the pylorus, from the incisura angularis, corpus and cardia and four biopsy specimens were taken from tongue-like columnar protrusions (<3 cm long) above the gastroesophageal junction. Tissue samples were stained with hematoxyline-eosine, HID-Alcian blue pH 2.5 and modified Giemsa. RESULTS: Of the 50 subjects who were found to have tongue-like columnar protrusions above the gastroesophageal junction, short segment Barrett's esophagus was detected in nine (18%). Whereas all short segment Barretti's esophagus cases were associated with chronic gastritis, Helicobacter pylori was found to be positive in five (55.5%) of them and there was intestinal metaplasia in other parts of the stomach (antrum in two patients, incisura angularis in three, antrum and cardia in one) in six (66.6%) cases. In 41 patients without short segment Barrett's esophagus 33 (80%) had chronic gastritis, 27 (66%) had Helicobacter pylori infection and eight had intestinal metaplasia in different locations (there in antrum, four in incisura angularis, one in the antrum and cardia) of the stomach. CONCLUSIONS: An association between short segment Barrett's esophagus and intestinal metaplasia was found in different parts of the stomach. The link between intestinal metaplasia in the stomach and these metaplastic changes in the tubular esophagus requires evalation in larger and more comprehensive studies.

Dietary nitrate and nitrite levels in an endemic upper gastrointestinal (esophageal and gastric) cancer region of Turkey.

BACKGROUND/AIMS: The aim of this study was investigate nitrate and nitrite levels in some traditional foods and drinking water in Van, an endemic upper gastrointestinal (esophageal and gastric) cancer region of Eastern Turkey. METHODS: Cheese with added herbs, drinking water, bread baked by wood fire and bread baked by burning animal manure specimens collected in the Van region were analyzed by Stahr's modification method. Nitrite was reduced to nitrate by the following three reagents: hydrazine sulphate ((NH2) 2SO4), CuSO4 and NaOH. Nitrate was then determined by coupling reagent containing sulphanlyamide, phosphoric acid and N-1-naphtyl ethylendiamine dihydrochloride. RESULTS: Nitrate and nitrite levels of all traditional foods and nitrite levels of drinking water were very significantly elevated compared to standard values (p<0.001- 0.01). CONCLUSIONS: These findings suggest that the influence of a traditional diet rich in nitrate and nitrite is significant in the development of endemic upper gastrointestinal (esophageal and gastric) cancers in the Van region of Turkey.

Heavy metals in soil, vegetables and fruits in the endemic upper gastrointestinal cancer region of Turkey.

The environmental exposure to heavy metals is a well-known risk factor for cancer. We investigated levels of seven different heavy metals, (Co, Cd, Pb, Zn, Mn, Ni and Cu) in soil, fruit and vegetable samples of Van region in Eastern Turkey where upper gastrointestinal (GI) cancers are endemic. Heavy metal contents of the samples were determined by flame atomic absorption spectrometer. Four heavy metals (Cd, Pb, Cu and Co) were present in 2- to 50-fold higher concentrations whereas zinc levels were present in 40-fold lower concentrations in soil. The fruit and vegetable samples were found to contain 3.5- to 340-fold higher amounts of the six heavy metals (Co, Cd, Pb, Mn, Ni and Cu) tested. The volcanic soil, fruit and vegetable samples contain potentially carcinogenic heavy metals in such a high levels that these elements could be related to the high prevalence of upper GI cancer rates in Van region.

A brucellosis case with ascites, hearing loss and pancytopenia.

To date there has been no association of ascites, hearing loss and pancytopenia in brucellosis in the literature. A 25-year-old female patient was hospitalized with fever, hearing loss, ascites and pancytopenia. Cultures from bone marrow and ascites yielded growth of Brucella melitensis and Brucella standard tube agglutination was found to be positive at a titer of 1/1280. The patient completely recovered by the sixth week following combined antibacterial treatment of ciprofloxacin, rifampin and doxychline.