Diverticular disease and posture during defecation : a prospective comparative study.

BACKGROUND AND STUDY AIMS: Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation. PATIENTS AND METHODS: This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662). RESULTS: The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis. CONCLUSION: Sitting during defecation seems to increase the risk of CD.

Irritable bowel syndrome in patients with chronic pruritus of undetermined origin.

BACKGROUND: Chronic pruritus is an important distressing condition that is often refractory to treatment. Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that occurs without an organic cause. OBJECTIVES: We aimed to investigate the relationship between chronic pruritus of undetermined origin (CPUO) and IBS. METHODS: Eighty patients with chronic pruritus (CP) of undetermined origin and fifty healthy control subjects without pruritus were included into the study. All of the participants were examined by a gastroenterologist for concomitant IBS. RESULTS: The frequency of IBS was found higher in patients with CP of undetermined origin (P: 0.02), but we did not observe any significant association between pruritus intensity and either presence of IBS (P: 0.08) or the subtypes of the syndrome (P: 0.40). Furthermore, patients with CP of undetermined origin between 40 and 60 years, female gender and longer duration of the disease were found to be significantly associated with the presence of IBS (P: 0.02, P: 0.01 and P < 0.001). CONCLUSIONS: We found that the frequency of IBS was higher in patients with CP than in healthy controls. Our study is the first report about the relation between CP of undetermined origin and IBS. Further studies with larger numbers of the patients are needed to show association between IBS and CPUO using laboratory tests to define underlying diseases such as lactose intolerance, functional dyspepsia and emotional diseases.

Evaluation of three instruments for laparoscopic cholecystectomy: harmonic scalpel, bipolar vessel sealer, and conventional technique.

AIM: Laparoscopy is the gold standard procedure in the surgery of gall bladder. Harmonic scalpel and bipolar vessel sealer are the other instruments for laparoscopic cholecystectomy. The aim of this study is to compare the effectiveness and safety of the three instruments for laparoscopic cholecystectomy. METHODS: A total of 60 patients were included into the study. Patients were divided into three groups. In Group A, cystic duct and artery were sealed using laparoscopic clips and gall bladder was dissected from the hepatic bed using electrocautery. In Group B, cystic duct and artery were sealed using Harmonic scalpel and gall bladder was dissected from the hepatic bed using Harmonic scalpel. In Group C, cystic duct and artery were sealed using Bipolar vessel sealer and gall bladder was dissected from the hepatic bed using Bipolar vessel sealer. Groups were compared for the following parameters: duration of surgery, amount of drainage, cystic duct opening pressure and cost. RESULTS: The duration of surgery was 31.5 ± 11.1 minutes in Group B, 33.1 ± 10 minutes in Group A, and 36.5 ± 9.9 in Group C; and the difference between Group B and Group C was statistically significant (P<0.04). Cystic duct opening pressure was highest in Group A which was 324.0 ± 23.4 mmHg. For all of these 3 groups total cost was found to be 900$, 2900$, 1800$ for groups A, B, and C; respectively. CONCLUSION: In laparoscopic cholecystectomy different energy source instruments may be safe to use with a cautious dissection and sealing of the cystic duct.

Increased H-FABP concentrations in nonalcoholic fatty liver disease. Possible marker for subclinical myocardial damage and subclinical atherosclerosis.

AIM: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder which is reported as the hepatic manifestation of metabolic syndrome with an increased risk of cardiovascular events. Patients with NAFLD are also at risk of future cardiac events independently of metabolic syndrome. The aim of this study was to examine serum concentrations of heart type fatty acid binding protein (H-FABP) in NAFLD and to investigate its correlations with metabolic parameters and subclinical atherosclerosis. PATIENTS AND METHODS: A total of 34 patients with NAFLD and 35 healthy subjects were enrolled in the study. NAFLD patients had elevated liver enzymes and steatosis graded on ultrasonography. Healthy subjects had normal liver enzymes and no steatosis on ultrasonography. H-FABP levels were measured using an enzyme linked immunosorbent assay (ELISA) method and correlations with metabolic parameters and subclinical atherosclerosis were examined. Subclinical atherosclerosis was determined with carotid artery intima-media thickness (CIMT) which was measured by high resolution B mode ultrasonography. RESULTS: H-FABP levels were elevated in patients with NAFLD (16.3 ± 4.0 ng/ml) when compared with healthy controls (13.8 ± 2.1 ng/ml; p < 0.001). NAFLD patients had significantly higher CIMT than the controls had (0.64 ± 0.17 mm vs. 0.43 ± 0.14 mm, p = 0.009). The H-FABP concentrations were significantly positively correlated with body mass index (r = 0.255, p = 0.042), fasting blood glucose level (r = 0.300, p = 0.013), CIMT (r = 0.335, p = 0.043), and homeostasis model assessment-estimated insulin resistance (HOMA-IR; r = 0.156, p = 0.306). In multiple linear regression analysis, H-FABP levels were only independently associated with CIMT (p = 0.04) CONCLUSION: Serum H-FABP concentrations increase in patients with NAFLD. Our results may not only suggest that H-FABP is a marker of subclinical myocardial damage in patients with NAFLD but also of subclinical atherosclerosis, independent of metabolic syndrome and cardiac risk factors.

Factors influencing skin ageing in a Mediterranean population from Turkey.

BACKGROUND: Skin ageing is a continuous process, with intrinsic factors determining which extrinsic factors (chronic sun exposure and other environmental factors, particularly smoking) have the greatest effect. AIM: To investigate the effects of lifestyle and environmental factors on skin ageing in a Mediterranean population from Ankara, Turkey. METHODS: In total, 574 (337 women, 237 men; age range 18-89 years) were enrolled into the study. Data were collected on age, gender, weight, height, body mass index (BMI), skin phototype, smoking status, consumption of alcohol (> 3 units/week) and coffee (> 1 cup/day), sun exposure, use of sunscreen and sunglasses, and involvement in sports and physical activities. The Daniell skin-wrinkling grading system was used as a marker of skin ageing. RESULTS: We found that male gender, chronic sun exposure and number of pack-years of cigarette smoking significantly contributed to the formation of facial wrinkles. There was a negative correlation between facial wrinkling and the use of sunscreen and sunglasses and facial wrinkling (P < 0.001 for both). We did not find any significant association between wrinkling score and alcohol consumption, coffee consumption, sports participation or d skin phototype. Moreover, wrinkling score was significantly higher in patients with a BMI < 25 kg/m(2) than in patients with a BMI > 25 kg/m(2) (P < 0.018). Multiple logistic regression analysis was conducted after adjusting for age, gender, smoking status, alcohol consumption, skin phototype, sun exposure, and use of sunglasses and topical sun protection. We found that gender and age were significantly associated with skin ageing (P < 0.014 and < 0.001, respectively). CONCLUSION: In this study, older age, male gender, low BMI, smoking and chronic sun exposure had a negative influence on skin ageing in a Turkish population.

Serum adenosine deaminase levels in diagnosis of acute appendicitis.

BACKGROUND: Adenosine deaminase (ADA) is found in most tissues including lymphoid cells and lymph nodes. It is a marker of T lymphocyte activation. The role of type 1 and type 2 T helper cells in appendicitis has been investigated experimentally. Serum ADA levels in acute appendicitis have not previously been studied. AIM: To assess the serum levels of ADA in patients with acute appendicitis. METHODS: Serum levels of ADA were investigated in 30 cases with acute appendicitis (mean age 26 years; male/female 17/13) and 21 healthy controls (mean age 40 years; male/female 11/10). Levels of ADA were compared in patients with acute appendicitis and healthy controls. Correlation analysis between ADA and other inflammatory markers (C-reactive protein (CRP), high-sensitivity CRP, erythrocyte sedimentation rate and white blood cell count) was also performed. RESULTS: Mean (SD) serum ADA levels were significantly higher in those with acute appendicitis than in the control group (13.41 (3.56) U/l vs 9.39 (1.22) U/l; p<0.001). There was no correlation between ADA and the other inflammatory markers investigated. CONCLUSIONS: Although serum levels of ADA do not correlate with other known inflammatory markers, its serum level is increased in acute appendicitis and it has a higher positive predictive value.

Churg-Strauss syndrome associated with acalculous cholecystitis and liver involvement.

We describe a 65-year-old man who had liver involvement with Churg-Strauss syndrome. He was admitted to the hospital because of fever, weight loss, dyspnea, abdominal pain, skin lesions and paraesthesias. His past medical history revealed a diagnosis of acalculous cholecystitis that had been made eight months earlier. Microscopic examination of a gall bladder biopsy specimen obtained at that time revealed an increase in extravascular eosinophils. There was evidence of a new bilateral pulmonary disease with bronchoconstriction and a transient infiltrated lesion in the right upper lung. The patient's white cell count was 14 620 per cubic millimetre, with 39% eosinophils (5800 per cubic millimetre) and 39% neutrophils. IgE was 503 g/L (normal range, 0 to 100 g/L). Liver function tests were mildly elevated. Fine needle liver biopsy showed active interface hepatitis. A diagnosis of Churg-Strauss syndrome was made. In this patient the syndrome occurred in a rare association with hepatitis, likely due to immunologic events in the liver. The patient was successfully treated with 60 mg/day of prednisolone monotherapy.