Primary gastric actinomycosis: a case report.

Gastric actinomycosis is an extremely rare disease. To date, about 20 cases have been reported in the literature. In most cases, diagnosis was made by histopathologic evaluation of an operative specimen. We report here a 68-year-old man with primary gastric actinomycosis who was admitted to the hospital with upper gastrointestinal bleeding and diagnosed as actinomycosis by microscopic examination of biopsy specimens obtained by endoscopy. This case is reported because of the rarity of endoscopically diagnosed primary gastric actinomycosis.

The search for a common thrombophilic state during the active state of inflammatory bowel disease.

The clinical course of inflammatory bowel disease (IBD) is frequently associated with thromboembolic complications. The aim of this study was to investigate common thrombophilic markers in Turkish patients with active IBD. Twenty-seven consecutive patients with IBD who were followed-up at the Hacettepe University Hospital were recruited. All the patients were in the active disease state. International normalized ratio, activated partial thromboplastin time, lupus anticoagulant, anticardiolipin IgG, IgM antibodies, protein C, protein S, antithrombin-III, factor V, and factor II mutation of all the IBD patients and of a sex-matched and age-matched control group of non-IBD patients were measured. International normalized ratio, activated partial thromboplastin time, protein C, protein S, lupus anticoagulant, anticardiolipin IgG and IgM, and Proteins C and S mutations were comparable between the 2 groups, but antithrombin-III was significantly lower in the IBD group compared with healthy control group (P<0.0001). As a conclusion, it is reasonable to assume that there may be a subpopulation of the patients with IBD, in whom thrombophilic abnormalities might be important for either disease manifestation or for thrombotic complications. Those hemostatic abnormalities could be either inherited or secondary to the ongoing disease process. Routine screening for the common markers of thrombophilia does not seem to be warranted unless simultaneous arterial and venous thrombosis, major organ thrombosis, strong family history of thrombophilia, unusual and recurrent thrombosis resistant to standard anticoagulant therapy are present. Further studies are definitely required to clarify these complicated associations.

The assessment of pancreatic exocrine function by bentiromide test in patients with chronic portal vein thrombosis.

INTRODUCTION: It has been noted in the literature that cavernous transformation of the portal vein (CTPV) can cause pancreatic duct atrophy, probably by enhanced collateral formation, but the clinical significance of this has not been established. AIMS: To evaluate whether CTPV affects the pancreatic exocrine functions. METHODOLOGY: Eighteen patients with CTPV were identified and prospectively studied. In these cases, despite a full clinical, biochemical, radiologic, and hematological evaluation, we found no etiologic factor for thrombosis in the portal vein (PV). All patients underwent a detailed evaluation for pancreatic morphology and pancreatic exocrine functions. In all cases, abdominal Doppler ultrasonography (US), abdominal spiral computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) were performed for evaluation of pancreatic morphology. For the purpose of this study, serial biochemical tests, including measurement of serum amylase, pancreatic amylase, lipase, glucose, calcium, and lipids, were performed every 3 months. All 18 patients also underwent a bentiromide test to determine whether there was any exocrine pancreatic insufficiency. The findings were compared with those for 20 healthy control subjects and reference controls. RESULTS: For all 18 patients with idiopathic CTPV and all controls, ERCP was performed successfully. The pancreatic duct was determined to be smaller than in control subjects and in a reference control group ( < 0.05). In this group serum pancreatic amylase, alkaline phosphatase, and direct bilirubin levels were found to be higher than in controls, and statistically important differences between the two groups ( < 0.05) were documented. In all 18 subjects the bentiromide test was well tolerated and was performed successfully. For 15 of them (83%), we found that urinary excretion of para-amino benzoic acid (PABA) was significantly less than in control subjects and the reference control group ( < 0.05). CONCLUSION: Pancreatic duct atrophy in patients with CTPV is clinically significant. When clinical signs are not manifest and routine biochemical tests are not useful for detecting exocrine pancreatic insufficiency, the bentiromide test is highly sensitive and specific for detecting probable pancreatic insufficiency in patients with CTPV.

Plasma thrombopoietin in patients with cavernous transformation of the portal vein.

Thrombopoietin (TPO), the primary regulator of thrombopoiesis, is produced mainly in the liver. Previous studies investigating blood TPO in chronic liver diseases revealed conflicting results. It has been suggested that hepatic TPO production is regulated by the portal blood supply to the liver. However, the role of TPO in the pathobiological basis of idiopathic portal vein thrombosis (PVT) and cavernous transformation of the portal vein (CTPV) has not been elucidated. The objective of this study is to assess plasma TPO concentrations in patients with CTPV. Eleven patients (4 men and 7 women, aged 38+/-12 years) with CTPV were studied. Sixteen healthy adults served as the control group (8 men and 8 women, aged 34+/-12 years). Median plasma TPO concentration was 326 pg/mL (range, 15-1402 pg/mL) in the patients with CTPV and 62.65 pg/mL (range, 38.5-102 pg/mL) in the control group (P = .003). In this study, we found significantly higher TPO concentrations in the plasma of patients with CTPV. The higher concentrations could be a result of the altered portal hemodynamics due to thrombosis. Moreover, TPO release by activated platelets might lead to the subsequent propagation of thrombosis in PVT.

Antiphospholipid antibodies and lipoprotein (a) as etiologic or contributory factors in patients with idiopathic cavernous transformation of portal vein.

BACKGROUND/AIMS: Antiphospholipid antibodies consisting of anticardiolipin antibodies and lupus anticoagulant are strongly associated with thrombosis in adult patients. It is also well known that there is a close relationship between antiphospholipid antibodies and lipoprotein (a) in thrombous formation. The aim of this study was to determine whether antiphospholipid antibodies and lipoprotein (a) have any effect on the formation of thrombosis in the portal vein of patients with 'idiopathic' cavernous transformation of the portal vein. METHODS: Twenty seven patients with idiopathic cavernous transformation of the portal vein (Group 1) seen at Hacettepe University Hospital were identified and prospectively studied. All were investigated for antiphospholipid antibodies and lipoprotein (a). Anticardiolipin antibodies, lupus anticoagulant and lipoprotein (a) were measured using commercially available kits. The findings of these 27 patients were compared with those of 20 healthy control subjects (Group 2). RESULTS: Anticardiolipin antibodies, especially ACA Ig G and lipoprotein (a) levels were found to be higher than of healthy controls and statistically significant differences were documented in two of these parameters, which seems to play an important role in thrombous formation in the portal vein. There was no correlation for lupus anticoagulant between the two groups. CONCLUSIONS: Anticardiolipin antibodies and lipoprotein (a) are strongly associated with thrombosis in the portal vein, producing a favorable medium for and acting as contributory factors in thrombous formation. It is suggested that these factors should be evaluated carefully in patients with 'idiopathic cavernous transformation of the portal vein'.