From dyspepsia to complicated peptic ulcer: new markers in diagnosis and prognosis.

OBJECTIVE: Peptic ulcer disease (PUD) may present with different clinical findings, ranging from mild dyspeptic complaints to mortal complications, such as gastrointestinal system perforation. The aim of this study was to investigate the potential blood parameters that can be used in the diagnosis of PUD and prediction of complications. PATIENTS AND METHODS: A total of 80 patients with dyspeptic complaints, 83 patients with PUD, and 108 patients with peptic ulcer perforation (PUP) who were treated in our hospital between January 2017 and December 2020 were included in the study. Clinical findings, laboratory data, and imaging methods were reviewed retrospectively. RESULTS: The mean age of 271 (154 men, 117 women) patients included in the study was 56.04 ± 17.98 (mean ± standard deviation) years. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), mean platelet volume, white blood cell, C-reactive protein, and neutrophil values were higher in patients with PUP compared to other groups (p < 0.001 for all). In the PUD group, only red blood cell distribution width was significantly higher compared to the patient group with dyspeptic complaints. In the postoperative period, NLR and PLR were significantly higher in patients who developed severe complications according to the Clavien-Dindo classification compared to patients who developed mild complications. CONCLUSIONS: This study showed that simple blood parameters can be used as diagnostic markers at different stages of PUD. NLR and PLR can be helpful in the diagnosis of PUP and red blood cell distribution width can be used to differentiate patients with peptic ulcer from dyspeptic patients. Additionally, NLR and PLR can be used to predict serious postoperative complications after PUP surgery.

Are m-cholinoceptors of guinea pig gallbladder smooth muscle of m4 subtype?

The antagonism of carbachol-induced contractions of guinea pig gallbladder smooth muscle strips via selective antagonists, methoctramine, HHSiD, pf-HHSiD and DABDMA has been investigated in order to find out the m-cholinoceptor subtype(s) of gallbladder smooth muscle. All m-cholinoceptor antagonists examined, displaced the concentration-response curves to the right parallel in a concentration-dependent manner without affecting the maximum response. Schild analysis of data was consistent with competitive antagonism. -log KB values of the antagonists were 7.37 for HHSiD, 7.53 for pf-HHSiD, 6.58 for DABDMA and 7.60 for methoctramine. These results, together with the high affinity of pirenzepine and low affinities of 4-DAMP and AF-DX 116, indicate that the m-cholinoceptors of the guinea pig gallbladder which mediate cholinergic contractions are not of m1-, m2- and m3- subtypes but seem likely to be of m4-subtype.

Effect of methylene blue on blood pressure in rats.

Methylene blue (MB) is a soluble guanylate cyclase inhibitor, and known as an endothelium-derived relaxing factor (EDRF) inhibitor in vitro. In the present study, it was demonstrated that intravenous administration of MB caused a dose-dependent hypertensive effect in rats. The hypertensive responses to the higher doses (10 and 20 mg/kg) of MB was followed by a reflex hypotension which did not appear in pithed rats. Noradrenaline depletion by reserpine pretreatment did not inhibit MB-induced hypertension, but abolished the hypotensive response. Both hypertensive and hypotensive phases were not altered by indometacin. These results may suggest that in vivo guanylate cyclase inhibition leads to an increase in blood pressure; prostaglandins and noradrenaline release from sympathetic nerve endings do not contribute to MB-induced hypertension and it may be due in part to the inhibition of EDRF.

Muscarinic receptor subtypes of guinea-pig common bile duct.

The antagonism of carbachol-induced contractions of guinea-pig common bile duct smooth muscle strips by various antagonists has been investigated in order to find out the muscarinic receptor subtype(s) of common bile duct smooth muscle. Atropine, pirenzepine, 4-DAMP and AF-DX 116 were used as nonselective, M1-selective, M1- and M3-selective and M2-selective muscarinic antagonists, respectively. All muscarinic antagonists examined displaced the concentration-response curves to the right, parallelly and in a concentration-dependent manner, without affecting maximum response. Schild analysis of data was consistent with competitive antagonism. pA2 values of the antagonists were as follows: atropine, 9.59; pirenzepine, 7.32; 4-DAMP, 8.99; AF-DX 116, 6.85. When these pA2 values are compared with those obtained in the ileum, it may be concluded that the muscarinic receptors of the guinea-pig common bile duct mediating cholinomimetic-induced contractions, are of the M3 subtype, but not of the M1 and M2 subtypes.