A Case of IgG4-related Mesenteritis and Ankylosing Spondylitis.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disease of unknown etiology and pathogenesis, which can affect all organs. The most commonly involved organs are the pancreas, hepatobiliary system, salivary glands, orbits and lymph nodes. Rarely, the thyroid, pituitary, aorta, lung and kidney may also be involved; mesenteric involvement is rare. The association of IgG4-RD with some rheumatological diseases is observed; while there are data in the literature about rheumatoid arthritis and Sjögren syndrome, but association with ankylosing spondylitis is rare. Anti-tumor necrosis factor alpha (anti-TNFα) treatment has been tried in refractory IgG4-RD cases; but this case is of great interest in terms of progressive presentation under treatment with etanercept, an anti-TNFα agent, which is also used for the treatment. But, IgG4-related mesenteritis with ankylosing spondylitis receiving anti-TNFα therapy, which has also been tried in the treatment of IgG4 disease, has not been reported in the literature. Key Words: IgG4-related disease, Mesenteritis, Ankylosing spondylitis.

A case of dasatinib-induced focal segmental glomerulosclerosis in a patient with Philadelphia chromosome positive chronic myeloid leukemia.

Focal segmental glomerulosclerosis is a common glomerular histological lesion, which is usually characterised by non-nephrotic range proteinuria or nephrotic syndrome. It may be idiopathic or occurs secondarily to drugs, diabetes, obesity or HIV nephropathy and other infections. Dasatinib, a tyrosine kinase inhibitor that has been used for the treatment of Philadelphia chromosome-positive chronic myeloid leukemia, has a few renal adverse effects. Exceptional cases with non-nephrotic range proteinuria have been reported in relation with dasatinib. In this case, we report a patient with symptoms of nephrotic syndrome and nephrotic range proteinuria, who was diagnosed as focal segmental glomerulosclerosis by kidney biopsy after treated with dasatinib.

A case of tuberculosis presented by obstructive jaundice tuberculosis-related mechanical icterus.

Obstructive jaundice caused by tuberculosis lymphadenitis is a rare condition. It can mimic clinical and radiological findings of hepatobiliary malignancies. The authors report a 24-year-old male patient who presented with abdominal pain, fever and jaundice for the last two weeks. It was found that cholestasis enzymes were increased by 2-3 fold and direct bilirubin was 6.13 mg/dL. Imaging studies revealed conglomerated lymph nodes with some cavitary lesions and dilated intrahepatic biliary canal secondary to compression by the lymph nodes. Tuberculosis was found to be positive in the polymerase chain reaction analysis of the aspirate that was obtained in the guidance of imaging studies. M. tuberculosis complex was isolated from mycobacterial culture. Anti-tuberculosis treatment was initiated. Clinical, laboratory and radiological findings completely resolved by medical therapy alone. Tuberculosis lymphadenitis should be kept in mind in cases presenting with obstructive jaundice in endemic areas and interventional diagnostic techniques should be preferred in eligible patients.

Psychiatric symptoms and relationship of disease with stress and traumatic experiences in patients with irritable bowel syndrome.

AIM: The aim of this study is to evaluate psychiatric symptoms in patients with irritable bowel syndrome (IBS) and investigate the relationship of traumatic life events with the disease. METHODS: Fifty-four patients and fifty healthy controls were included in this study. Psychiatric symptoms were measured with the Symptom Checklist-90-R (SCL-90R), State-Trait Anxiety Inventory (STAI) and sociodemographic information form were used. All scales were applied to both IBS cases and healthy control groups. RESULTS: Somatization, obsessive-compulsive disorder, anger hostility, additional items and total scores of SCL-90-R were higher in the IBS group compared to the control group. Trait anxiety was significantly higher in the IBS group and state anxiety, significantly higher in the control group. In those with a personal history of traumatic events, all subscales and total scores of SCL-90-R were increased significantly. Scores of psychiatric scales, which indicate stressful life events, were significantly higher before the onset of abdominal pain. CONCLUSIONS: Environmental factors that cause considerable emotional distress, such as chronic stress, trauma, and abuse, have been linked to IBS and the severity of symptoms. Therefore, it is important to consider the psychiatric symptoms in the management of IBS.

Non-invasive ventilation in palliative care: a systematic review.

INTRODUCTION: An ageing population and steady increase in the rates of neoplasms and chronic degenerative diseases poses a challenge for societies and their healthcare systems. Because of the recent and continued advances in therapies, such as the development and widespread use of non-invasive ventilation (NIV), survival rates have increased for these pathologies. For patients with end-stage chronic respiratory diseases, the use of NIV following the onset of acute or severe chronic respiratory failure is a valid option when intubation has been excluded. EVIDENCE ACQUISITION: The following electronic databases were searched from their inception to January 2000 to December 2017: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), the Cochrane Database of Systematic Reviews, ACP Journal Club database. EVIDENCE SYNTHESIS: The available evidence strongly supports the use of NIV in patients presenting with an exacerbation of chronic obstructive pulmonary disease, as well end-stage neuromuscular disease. Few studies support the use of NIV in end-stage interstitial lung disease and in morbid obesity patients. In patients with cancer has been recommend offering NIV as palliative care to improve dyspnea. CONCLUSIONS: The decision regarding the treatment should be made by the patient, ideally before reaching the terminal stage and after having a frank dialogue with healthcare professionals and family members.

Radiology findings and non-invasive ventilation response.

Although NIV is a simple and useful method, considerable variation in its use across countries, regions and hospitals may be noted. The patient should be evaluated according to subjective response (respiratory distress, consciousness, problems related to mask and airflow), physiological responses (respiration rate, respiratory effort, air leakage) and patient-ventilator compliance (gas exchange, pulse oximetry, arterial blood gases). Normalization in respiration rate within 1 or 2 hours after initiation of treatment is one of the most important markers for recovery. The goal is to maintain respiration rate between 20 and 30 breaths/minute. Reduction in intercostal and supraclavicular retractions, paradoxical respiration and sympathetic activity indicate success of treatment. Arterial blood gases are measured within first 2 hours in order to assess pH and CO2; and as needed thereafter. In general, NIV is assessed by arterial blood gases, hemodynamic parameters and several laboratory tests. There is limited number of studies in NIV. Here, we aimed to assess radiological implications of gas distribution within lung tissue during NIV therapy.

Comparison of Survival Rates, Tumor Stages, and Localization in between Obese and Nonobese Patients with Gastric Cancer.

Purpose. In this study we tried to determine the association between body-mass index (BMI), survival rate, and the stage of tumor at the time of diagnosis in patients with gastric cancer. Methods. A total of 270 gastric cancer patients' hospital records were retrospectively evaluated. Patients were grouped according to their BMI at the time of tumor diagnosis. Tumor stages at admission were compared according to their BMI values. Results. There were no differences in OS among BMI subgroups (p = 0.230). The percent of patients with stage III tumor was significantly higher in nonobese while the percent of stage IV tumor was surprisingly higher in obese patients (p was 0.011 and 0.004, resp.). Percent of patients who did not have any surgical intervention was significantly lower in overweight and obese patients than normal and/or underweight patients. Conclusions. At the time of diagnosis, obese patients had significantly higher percent of stage IV tumor than nonobese patients. Despite of that, there were no differences in survival rates among BMI subgroups. Our study results are consistent with "obesity paradox" in gastric cancer patients. We also did not find any relationship between BMI and localization of gastric tumor.

Mean platelet volume in patients with biliary and non-biliary acute pancreatitis.

INTRODUCTION: Acute pancreatitis (AP) is a systemic inflammatory disease. We aimed to detect whether there was a change of mean platelet volume (MPV) level on onset and remission patients with biliary and non-biliary acute pancreatitis. MATERIALS AND METHODS: In our emergency service patients diagnosed with biliary and nonbiliary AP were analyzed retrospectively. Laboratory results measured in onset and remission were recorded and compared. RESULTS: Total number of patients enrolled in our study was 331 (177 female). 194 cases were classified as biliary and 137 were as non-biliary AP. Average age and numbers of female patients of biliary cases were higher than that of nonbiliary cases. Initial MPV values were lower than remission values in all patients with AP. In biliary group initial MPV was 8.42 ± 1.04 and remission value was 8.71 ± 1.12. In nonbiliary group initial MPV was 8.07 ± 1.02 and remission value was 8.4 ± 1.06. In both groups on onset had lower mean MPV levels than those in remission (P = 0.0001 both of them). CONCLUSIONS: MPV values were higher than initial values in remission period in patients both of groups. MPV was lower in non-biliary AP group than biliary AP group that can be an indicator of early-onset infection.