Vitamin D Receptor Level in Biopsy Specimen of Patients with Ulcerative Colitis: Results from a Center in Western Anatolia.

BACKGROUND: Ulcerative colitis (UC) is a chronic, inflammatory bowel diseases characterized by uncontrolled inflammatory condition of the colon and rectal mucosa marked by recurrent periods of remission and exacerbation. Vitamin D receptor (VDR) is a member of the steroid receptor family that mediates the effects of vitamin D by regulating transcription of multiple cellular genes. We aimed to evaluate vitamin d receptor level in biopsy specimen of patients with UC in this study. METHODS: VDR levels were retrospectively studied in colon biopsy specimens of UC patients. The Spearman's rho correlation analysis, The Kolmogorov-Smirnov, Mann Whitney U, and chi-square tests were used for statistical analysis. The p values below 0.05 were considered statistically significant. RESULTS: Study included 112 UC patients (65 male and 47 female) and 30 controls (19 female and 11 male) who had normal results in biopsy examinations carried out due to various reasons. VDR levels of UC patients were statistically lower than control subjects, and was not associated with duration of the disease and place of involvement. CONCLUSIONS: VDR is an important receptor in the pathogenesis of UC, and optimizing vitamin D levels could have a therapeutic role in UC.

Cetirizine-induced hepatotoxicity: case series and review of the literature.

Drug-induced liver damage is a frequently encountered clinical table caused by many drugs. Cetirizine is a widely preferred and prescribed antihistaminic agent for allergic disorders due to its non-sedative properties. In view of the literature, we present four cases of hepatotoxicity due to cetirizine use. We conclude that in patients with high levels of liver enzymes of unknown origin, cetirizine as well as other hepatotoxic drugs should be reconsidered.

Telomeric restriction analysis of vascular smooth muscle cells following balloon angioplasty in rabbits

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Intimal hyperplasia due to smooth muscle cell proliferation and migration has been reported to be responsible for the pathogenesis of atherosclerosis and restenosis, manifested following balloon angioplasty. In this study, we employed the balloon angioplasty model to study telomere length regulation in proliferating vascular smooth muscle cells. Our results showed that balloon angioplasty in iliac arteries resulted in intimal hyperplasia due to proliferation of the smooth muscle cells and small size telomeric restrictional fragments were evident in injured arteries (AU)

Telomeric restriction analysis of vascular smooth muscle cells following balloon angioplasty in rabbits.

Intimal hyperplasia due to smooth muscle cell proliferation and migration has been reported to be responsible for the pathogenesis of atherosclerosis and restenosis, manifested following balloon angioplasty. In this study, we employed the balloon angioplasty model to study telomere length regulation in proliferating vascular smooth muscle cells. Our results showed that balloon angioplasty in iliac arteries resulted in intimal hyperplasia due to proliferation of the smooth muscle cells and small size telomeric restrictional fragments were evident in injured arteries.

The effects of calcium channel blockers are not related to their chemical structure in the collar model of the rabbit.

Placing a silicone collar around the rabbit carotid artery induces intimal thickening, an early stage in atherosclerosis and restenosis. We investigatedwhethertreatment with oral pranidipine, a new potent, long-lasting dihydropyridine calcium channel blocker (CCB), inhibited collar-induced intimal thickening in addition to the changes in vascular reactivity usually observed in this model. Pranidipine treatment did not inhibit collar-induced intimal thickening. Placing the collar around the carotid artery resulted in the characteristic changes in vascular reactivity, such as increased sensitivity to 5-hydroxytryptamine. Treatment with Nomega-nitro-L-arginine (100 microM) and pranidipine, however, did not affect collar-induced changes in vascular reactivity. From results of this and previous studies, we conclude that pranidipine does not prevent collar-induced intimal thickening or collar-induced changes in vascular reactivity. Not all CCBs prevent collar-induced intimal thickening, suggesting that the effects of these agents are not related to their chemical structure and/or their calcium channel-blocking actions.

DNA analysis and DNA ploidy in gastric cancer and gastric precancerous lesions.

Gastric cancer (GCa) is still a common cause of cancer-related deaths worldwide, despite improved diagnostic and therapeutic implications. Hence, early diagnosis has critical importance. Flow cytometry reveals rapid and reproducible quantification of nuclear DNA content of disaggregated tissues and assessment of its significance in various malignant and precancerous lesions. A total of 121 patients with GCa, chronic atrophic gastritis (CAG), gastric polyps, intestinal metaplasia (IM) and gastric dysplasia and 36 healthy controls were enrolled in this study. Flow cytometric measurements of DNA ploidy, total S-phase, G2M-phase and proliferative indexes (PIs) were analysed on fresh gastric biopsy specimens obtained by gastroscopy. DNA aneuploidy was present in 43.75% of the GCas (p < 0.05). We found a DNA aneuploidy rate of 15.38% in CAG, 15.38% in IM and 25% in epithelial dysplasia. One of nine polyps had aneuploidy. None of the normal gastric mucosa samples showed aneuploidy. The controls had lower rates of total S-phase and PIs (p < 0.05). In conclusion, DNA flow cytometry may be offered as an objective diagnostic tool for early detection of malignant transformation in gastric lesions.

Partial seizure: an unusual cause of recurrent vomiting.

Partial seizure is a rare cause of nausea and vomiting. We report an adult patient with abdominal discomfort lasting 15 years accompanied by nausea and vomiting at least twice a week. On admission, physical examination and detailed laboratory tests were normal. Abdominal ultrasound examination, upper gastrointestinal endoscopy and CT scanning of the brain did not reveal any evidence of disease. Electroencephalography revealed bilateral synchronous sharp wave discharges and spike wave activities. The diagnosis of partial seizure was considered and the patient was administered sodium valproate. The patient's symptoms subsided and he has been asymptomatic for the past 20 months. We conclude that partial seizure should be considered in patients suffering from abdominal complaints who do not have any underlying gastrointestinal disorder.

Plummer-Vinson syndrome: a report of three cases.

Plummer-Vinson syndrome is characterised by dysphagia, anaemia, glossitis and oesophageal web. We report our findings in three patients with membranes in the upper oesophagus. All patients underwent endoscopic dilatation and iron replacement therapy, with good results. We review the literature of this syndrome.

In treatment of active duodenal ulcer and Helicobacter pylori eradication.

AIM: To compare the efficacy of lansoprazole and pantoprazole in treatment of active duodenal ulcer and Helicobacterpylori eradication. METHODOLOGY: A total of 50 patients, with a positive rapid urease test and endoscopically diagnosed active duodenal ulcer, were randomly assigned to one of two treatment groups after endoscopic examinations. Patients in the first group received lansoprazole 30 mg b.d., amoxycillin 1000mg b.d., clarithromycin 500 mg b.d.; patients in the second group received pantoprazole 40 mg b.d., amoxycillin 1000 mg b.d., clarithromycin 500 mg b.d for two weeks. Patients were scheduled for repeat endoscopic examination; repeat rapid urease test, and histological examination 4 weeks after the end of the therapy. RESULTS: Hp was eradicated in 84.2% of the patients received lansoprazole and in 83.3% of the patients received pantoprazole. The difference was not significant (P>0.05). In the lansoprazole group 90.5%, and in the pantoprazole group 83.3% of the patients experienced complete duodenal ulcer healing at the time of follow-up endoscopic examination. We found no statistical significant difference between the two groups. CONCLUSION: Lansoprazole and pantoprazole both have similar effect in eradication of Hp, and in terms of ulcer healing. Comparative studies in larger trials are needed to compare the efficacy of lansoprazole and pantoprazole in treatment of active duodenal ulcers.

A new percutaneous approach for the treatment of hydatid cysts of the liver.

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.

Flow cytometric DNA analysis, and immunohistochemical p53, PCNA and histopathologic study in primary achalasia: preliminary results.

BACKGROUND/AIMS: Primary achalasia is a premalignant disorder of the esophagus. The studies for esophageal cancer pathogenesis may reveal early diagnosis of esophageal cancer. DNA aneuploidy, p53 mutations and cellular proliferation are important factors in cancer development. As far as we know, we have not encountered any study on these factors in achalasia. METHODOLOGY: We studied DNA ploidy by flow cytometry and p53 and PCNA index by immunohistochemical technique and studied histopathology in the esophageal mucosa of primary achalasia and control patients. RESULTS: DNA analysis revealed aneuploidy in 2 of 20 achalasia patients but none of the 18 control patients. Sixty-five percent of achalasia and 22% of normal patients showed p53 positivity (P < 0.05). We have found normal mucosa, basal cell hyperplasia-esophagitis and dysplasia in 13, 22 and 3 patients and p53 positivity in 2, 12 and 3 of these patients, respectively (P < 0.05). PCNA labeling indexes (as % +/- SD) were 34.8 +/- 12.2, and 28.4 +/- 9.3 in achalasia and control groups, respectively (P > 0.05). PCNA labeling index was 28.0 +/- 8.2 in p53(-) and 36.0 +/- 12.9 in p53(+) patients (P < 0.05). PCNA indexes were found 29.3 +/- 9.6 in normal histopathologic group, 31.8 +/- 13.4 in basal cell hyperplasia-esophagitis, and 41.7 +/- 6.5 in dysplasia group (P > 0.05). CONCLUSIONS: DNA aneuploidy, p53 positivity, and higher cellular proliferation index may have important role in the pathogenesis of esophageal cancer in primary achalasia.

Mucosal antioxidant defense is not impaired in ulcerative colitis.

BACKGROUND/AIMS: In this study, mucosal antioxidant defense was investigated in the biopsy samples from 12 patients with active ulcerative colitis and from 13 patients under remission. METHODOLOGY: Biopsy samples obtained from healthy colon parts of the same subjects were used as control. RESULTS: No changes were observed between superoxide dismutase, glutathione peroxidase and catalase enzyme activities of control or inflamed biopsy samples. However, antioxidant potential values were found to be higher and malondialdehyde levels lower in inflamed samples compared with controls. CONCLUSIONS: Our results show that in contrast to previous suggestions, mucosal antioxidant defense is not impaired in ulcerative colitis.

Antioxidant enzyme activities and total nitrite/nitrate levels in the collar model. Effect of nicardipine.

There is a large body of literature describing the causative role of oxidative stress mediated by increased levels of reactive oxygen species in the pathogenesis of cardiovascular disease such as atherosclerosis, hypertension, and restenosis after angioplasty. The positioning of a soft silicone collar around the rabbit carotid artery elicits intimal thickening. The findings from recent studies demonstrated that both intimal thickening and atherosclerosis lead to synthesis of inducible nitric oxide synthase, resulting in abundant amounts of nitric oxide. We investigated the effects of collaring and nicardipine treatment on the activities of antioxidant enzymes, superoxide dismutase and catalase, and total nitrite/nitrate levels, stable products of nitric oxide. Placing the collar increased the total nitrite/ nitrate levels and decreased superoxide dismutase activity in collared arteries. Treatment with nicardipine (20 mg/kg/day, s.c.) prevented enhanced nitric oxide degradation without affecting superoxide dismutase and catalase activities. Our results suggest that enhanced nitric oxide production and superoxide anion are generated in response to the collaring, resulting in oxidative stress within the segment in this model.

Antioxidant status of erythrocytes from patients with cirrhosis.

BACKGROUND/AIMS: The aim of the present study was to investigate possible involvement of oxidant stress in the anemia of cirrhotic patients and to assess blood antioxidant status of these patients. METHODOLOGY: Superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzyme activities were measured in the erythroctes from patients with liver cirrhosis and from controls. Levels of thiobarbituric acid reagent substance were also measured in the erythrocyte (TBARSe) and plasma (TBARSp) samples of the groups. RESULTS: Lower activities of SOD and GSH-Px were established in the erythrocytes from patients compared with control subjects. No differences were found between erythrocyte TBARS levels of control and patient groups. Plasma TBARS levels were, however, found to be significantly higher in the patient groups compared with controls. CONCLUSIONS: Results suggest that although enzymatic antioxidant defense system is significantly reduced in the erythrocytes from cirrhotic patients, this does not lead to further peroxidative reactions in the erythrocytes, possible due to preoxidation of some cellular structures sensitive to peroxidative attacks. There was, however, an important indication of accelerated peroxidative reactions in the plasma of the cirrhotic patients, which possibly resulted from extracellular oxidant stress in these patients.

Tc-99m dextran and Tc-99m HIG findings in patients with ulcerative colitis.

PURPOSE: Various radionuclide methods have been studied for the evaluation of the disease activity and extent of ulcerative colitis and other protein-losing enteropathies. Recently, Tc-99m dextran and Tc-99m human immunoglobulin (HIG) have been used to detect inflammation and protein loss into the intestine, but only a few studies have been reported with these agents. MATERIALS AND METHODS: In this study, Tc-99m dextran and Tc-99m HIG were used to evaluate disease activity and extent in patients with ulcerative colitis. These agents were used in 12 patients with active disease and in five patients in remission, and five healthy control participants also were included. RESULTS: Large bowel activity was detected in 11 of the 12 patients with active ulcerative colitis using Tc-99m dextran and in 10 patients using Tc-99m HIG. Fifty-eight bowel segments were found to be active with endoscopy, 39 with Tc-99m dextran, and 31 with Tc-99m HIG. No intestinal activity was detected in the control participants. Grade 1 activity localization in the large bowel was detected in three patients with ulcerative colitis in remission using Tc-99m dextran and in one patient using Tc-99m HIG. CONCLUSION: Tc-99m dextran is more sensitive for detecting disease activity and extent than is Tc-99m HIG.

Effects of treatment with FK409, a nitric oxide donor, on collar-induced intimal thickening and vascular reactivity.

Intimal thickening in arteries is considered a site of predilection for atherosclerosis. In a rabbit model of early atherosclerosis, a silastic collar was placed around the carotid artery, which resulted in the formation of intimal thickening. We investigated whether the oral application of FK409 ((+/-)-(E)-4-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexenamide , 10 mg kg(-1) day(-1), p.o.), a nitric oxide donor, inhibited the collar-induced intimal thickening as well as accompanying reactivity changes in rabbit carotid artery. The intimal thickening was significantly inhibited by FK409. The collar treatment increased the pD2 value of 5-hydroxytryptamine (5-HT) whereas it decreased those of phenylephrine and acetylcholine and did not significantly alter that of nitroglycerine. Maximal contractile force development in response to potassium chloride (KCl), 5-HT and phenylephrine was decreased in collared arteries. The collar did not alter the maximal relaxant effects of acetylcholine and nitroglycerine. Despite the significant reduction of intimal thickening, FK409 treatment did not affect these collar-induced modifications in vascular reactivity.

Effects of nicardipine on collar-induced intimal thickening and vascular reactivity in the rabbit.

The effects of nicardipine treatment on collar-induced intimal thickening and on accompanying reactivity changes in rabbit carotid artery have been investigated. Treatment for three weeks with subcutaneous nicardipine (20 mgkg(-1) per day) significantly inhibited the intimal thickening caused by perivascular application of a silicone rubber collar. Potassium chloride (KCl), phenylephrine and 5-hydroxytryptamine (5-HT) induced concentration-dependent contractions in both sham-operated and collared arteries. Collar-induced attenuation of maximum KCl-, phenylephrine- and 5-HT-induced contraction was not affected by nicardipine. Collaring caused the means of pD2 values (the negative logarithm of EC50 values, 50% effective concentration) of 5-HT and phenylephrine to increase and decrease, respectively. Nicardipine did not affect the altered sensitivity to these agonists. Neither collar implantation nor nicardipine treatment altered the pD2 values for acetylcholine- and nitroglycerine-induced relaxations. These results demonstrate that nicardipine inhibits collar-induced intimal thickening in rabbit carotid artery without affecting the accompanying changes in vascular reactivity, indicating a possible lack of association between the development of intimal thickening and altered reactivity.

Opioid receptor ligands in human hepatic encephalopathy.

BACKGROUND/AIMS: Opioid peptides may contribute to some of the manifestations of hepatic encephalopathy. To address the role of the opioid system in the pathogenesis of hepatic encephalopathy, three representative opioid ligands were measured in plasma and cerebrospinal fluid of patients with hepatic encephalopathy. METHODS: Plasma and cerebrospinal fluid were obtained in three groups of patients: group 1: patients with hepatic encephalopathy; group 2: patients with lumbar back pain; group 3: healthy controls. Met-enkephalin, leu-enkephalin and beta-endorphin levels were measured in extracted plasma and cerebrospinal fluid samples by radioimmunoassay. RESULTS: Plasma met-enkephalin levels were 656% (p<0.05) and 301% (p<0.05) and cerebrospinal fluid met-enkephalin levels were 1481% (p<0.01) and 645% (p<0.05) higher when compared to healthy control and pain control patients, respectively. Although plasma and cerebrospinal leu-enkephalin levels were elevated in patients with hepatic encephalopathy, the increases were not statistically significant. Plasma and cerebrospinal beta-endorphin levels were similar in the three study groups. CONCLUSIONS: The results of this study support accumulating data on the role of the delta opioid receptor ligand met-enkephalin in the pathogenesis of hepatic encephalopathy, and provide a rationale for the use of opioid receptor antagonists in the treatment of hepatic encephalopathy.

The effects of gentamicin and vitamin E on enzymatic antioxidant defence in guinea-pig lung.

OBJECTIVE: To study the possible effects of gentamicin on the enzymic free-radical defence system in the lung. METHOD: Activities of cytoplasmic superoxide dismutase (CuZn-SOD), mitochondrial superoxide dismutase (Mn-SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) enzymes were studied in lung tissues from gentamicin-treated guinea-pigs compared to controls. RESULTS: Levels of those enzymes were higher in the gentamicin group except for xanthine oxidase (XO) activity. Vitamin E given concomitantly with gentamicin caused significant decreases in CuZn-SOD, Mn-SOD and GSH-Px activities but an increase in CAT activity in the lung tissue. Only vitamin treatment caused significant decreases in the activities of CuZn-SOD, Mn-SOD and GSH-Px enzymes and an increase in CAT activity. CONCLUSION: The results suggest that lung tissue is able to respond quickly and effectively against the adverse effects of some oxidant substances by inducing and/or activating the enzymatic free-radical defence system.