Lipoma causing ileocecal intussusception and its endoscopic resection.

INTRODUCTION: In adults, intussusception is a rare disorder, and it might lead to acute mechanical intestinal obstruction, (AMIO) which is not typically considered in the differential diagnosis. Our case report presents a rare, fully endoscopic management of an ileocecal intussusception without any further surgical intervention. Endoscopic manipulations of such distant lesions under correct indications will surely avoid unnecessary surgery and increase patient comfort. CASE DESCRIPTION: A 58-year-old male was admitted with complaints of nausea, vomiting, abdominal pain, and distention. Physical examination, blood tests and radiological assessments revealed the patient was suffering from AMIO. The cause of AMIO was ileocecal intussusception due to an ileal lipoma. After intussuscepted segment was uncluttered by endoscopic pneumatic reduction(ER), ileal lipoma was resected colonoscopically. The patient was discharged without any complications. DISCUSSION: Intussusception may appear because of benign or malignant etiologies. Cases in which malignancy is ruled out, endoscopic resection can be utilized safely in diagnosis and treatment. Endoscopic resection will also save the patient from unnecessary and costly surgical interventions.

Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase.

INTRODUCTION: Acute pancreatitis (AP) is the third most common gastrointestinal disease at hospital admission. The etiology and pathogenesis of this disease are not completely clear. Our study was intended to determine the systemic levels of pentraxin-3 (PTX-3), myeloperoxidase (MPO), procalcitonin (PCT), and C-reactive protein (CRP) as prognostic parameters in early stages of AP. We also determined the effects of treatment on PTX-3, MPO, PCT and CRP levels in AP. MATERIAL AND METHODS: The study group comprised 44 AP patients (22 male, 22 female; age: 49.3 ±16.9 years) referred to our outpatient clinic. Additionally, our investigation included a control group of 30 healthy volunteers (18 male, 12 female; age: 50.8 ±12.6 years). RESULTS: Leukocytes, glucose, aspartate aminotransferase (AST (SGOT)), alanine aminotransferase (ALT (SGPT)), alkaline phosphatase (ALP), total and direct bilirubin levels were significantly higher in the AP group (p < 0.05, all). CRP, PTX-3, MPO and PCT were considerably higher in the AP group (p < 0.001, all), and after treatment, CRP, PTX-3, MPO and PCT levels were significantly lower (p < 0.001, all). CONCLUSIONS: Our findings indicated that the CRP, PTX-3, MPO and PCT levels increase in patients with AP and hence these indicators can be used as diagnostic factors to predict inflammation severity in AP. It was revealed that after treatment, there were significant reductions in biomarker levels. However, further research is needed in order to understand how these biomarkers can help to monitor inflammatory responses in AP.

The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients.

BACKGROUND: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). METHODS: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m2), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m2) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. RESULTS: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. CONCLUSIONS: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period.

Pyoderma gangrenosum with common variable immunodeficiency.

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease of unknown etiology. It can be seen on normal skin or secondary to traumas such as injections and biopsies. Half of reported cases are associated with systemic diseases such as arthritis, inflammatory bowel diseases, hematological disorders, hepatic disease, and necrotizing vasculitis. These lesions often occur on the trunk and extremities. Abscess drainage, debridement, or necrosectomy are contraindicated in PG, and false management of these indications aggravates the lesion. A diagnosis of PG is based on medical history as well as physical and laboratory examination according to standard criteria. Presented here is a case of a male patient with a medical history of recurrent abscess of injection and splenectomy due to splenic abscess. The patient presented with a subcutaneous abscess which transformed rapidly to an ulcer after abscess drainage. Consequently, the patient received the final diagnosis of PG with common variable immunodeficiency and was treated accordingly.

Increased MPV is not a significant predictor for preeclampsia during pregnancy.

BACKGROUND: Preeclampsia, defined as the presence of hypertension and proteinuria, is usually related with maternal and neonatal adverse effects. However, the exact predictor of preeclampsia is still lacking. Even though there are some conflicting data, mean platelet value or MPV, that is, platelet ratio with or without Doppler velocimetry was determined as highly sensitive markers for preeclampsia. We aimed to investigate the utility of MPV in prediction of preeclampsia. METHODS: Seventy-four preeclamptic pregnant women (21 in mild, 53 in severe preeclampsia groups) were included in the study. To assess the difference of MPV between preeclamptic, normal pregnant, and healthy control rather than mild and severe preeclamptic pregnant women, we included in the analysis 31 healthy pregnant women and 35 healthy nonpregnant women. RESULTS: Mean age of the preeclamptic patients was 25.3 (17-38) years. Platelet levels were higher in mild preeclampsia (group 1) than severe preeclampsia (group 2), whereas alanine aminotransferase (AST), hemoglobin, and hematocrit level was higher in group 2. MPV levels were found to be similar in groups 1 and 2, MPV level increased from healthy control to preeclamptic women (P = 0.003). MPV:platelet ratio was similar according to the severity of preeclampsia (P = 0.123). Doppler velocimetry did not add an additional benefit to predict preeclampsia or its severity. CONCLUSION: Our results showed that MPV level was higher in the pregnant than the control group. However, MPV did not differ both between mild and severe preeclampsia, and preeclampsia and non-preeclamptic pregnant women.