Vitamin D and Colorectal Carcinogenesis

Colorectal cancer is the second leading cause of cancer-related death in the Western industrialized world. Many epidemiological studies have shown a negative association between colorectal cancer incidence and vitamin D levels. It has been suggested that the antitumoral action of 1,25(OH)2D3 in colorectal cancer relies on several mechanisms at the cellular level. This prompted us to evaluate expression of certain immunohistochemical markers during tumor progression in colorectal human tissue and to study for the first time the relationship between histological type and grade of colorectal tumors with the expression of these markers. The investigated markers were the ones responsible for apoptosis (PAK1 and p53), cell adhesion (beta-catenin), differentiation (p53), and proliferation (Ki67). We also analyzed the correlation of their expression with vitamin D blood levels in these patients. Our results showed that the expression of these biomarkers increased with progression from colorectal adenomas to carcinomas. Expression of PAK1, beta-catenin, and p53 in the nucleus correlated with advanced stages of carcinoma. Low vitamin D blood levels correlated with nuclear accumulation of p53, nuclear beta-catenin expression, and expression of Ki67

Treatment of Achalasia with Botox injection

Achalasia represents the absence of lower esopaheal sphincter relaxation and absence of normal peristalsis of the esophageal body, showed in incidence of 1-2 patients in 100 000 people. Causes of achalasia are of unknown ethiology or secondary causes. It is present equally in men and women, at every age. Presence of alarm symptoms, such as dysphagia, weight loss, regurgitation, anemia, family history of cancer, warrant further investigation. Specific testing is needed to distinguish achalasia from other disorders. For diagnosis, upper endoscopy, esophagogram, high resolution esophageal manometry are needed. In distinguished cases, abdomen and chest CT scan and pH testing are performed as well. There are several treatment modalities for achalasia. Botulin toxin injection is known since 1995, from Pasricha and Kalloo. Botulin toxin injection is an effective and safe treatment. Our presentation is a success story and the first injection, in our state, of Botulinum toxin in order to improve the symptomatic dysphagia, in a 73-year-old man, who had cardiopulmonary contraindications for surgery. Our presentation is a successful story of the injection of Botulinum toxin in order to improve the symptomatic dysphagia, in a 73-year-old man, who had cardiopulmonary contraindications for surgery. Even after 6 months he feels quite well

THE MEDICAMENTOSE AND ENDOSCOPIC TREATMENT OF NONVARICEAL UPPER GASTROINTESTINAL BLEEDING

The endoscopic treatment is one of the most common therapy for bleeding peptic ulcer. Administration of PPI after successful injected therapy with epinephrine is of great importance. This study has the aim to show the efficacy of the PPI treatment after endoscopic injected of epinephrine in the patients with bleeding peptic ulcer. METHODS. In this study are included 102 patients with active bleeding or with nonbleeding visible vessels, after beginner hemostasis with endoscopic injection of epinephrine (1:10 000). These patients are randomized in two groups. The first group with 22 patients were treated with PPI, 40 mg pantoprazole infusion every 6 hours for 3 days and the second group with 80 patients were treated with 50 mg ranitidine infusion every 8 hours for 3 days. All the patients were followed for survey characteristics during 14 days after the first examination. RESULTS. Episodes of rebleeding were lower in the group of patients treated with PPI every 6 hours, 7.1% (2/28) compared with the group of patients treated with Ranitidine every 8 hours, 15% (12/80). The volume of the transfused blood in the group of patients treated with PPI was lower than in the group of patients treated with ranitidine, 930 ml vs 1540 ml and p\u3c0.001. The days of hospital stay (9 vs 11 , P\u3e0.05) Number of patients who need the surgical intervention (10.7% vs 12.5% , P\u3e 0.05) and mortality rate (3.6% vs 6.25% , P\u3e 0.05) were without statistically significance between two groups. CONCLUSION. Combination of the endoscopic epinephrine injection and administration of high doses of PPI in infusion was more effective than combination of endoscopic injection with epinephrine and ranitidine in infusion for prevention of the re-bleeding from peptic ulcer with active bleeding or nonbleeding visible vessels

Bleeding Peptic Ulcer and Helicobacter Pylori Infection

The aim of this study was to investigate the prevalence of infection with H. pylori in patients with peptic ulcer bleeding, the effect of triple therapy (OAC) on the eradication of H. pylori infection, as well as the influence of H. pylori eradication in the appearance of recurrent bleeding peptic ulcer. The research group of 40 patients with positive history of bleeding from gastric or duodenal ulcers, underwent upper endoscopy and first-rate endoscopic hemostasis. The patients were examined at the Endoscopic Service of the Gastroenterology Clinic with Hepatology. The defect in the stomach wall and duodenum over 5 mm confirmed with endoscopy, symptom-defined bleeding and endoscopic signs were the main criteria for being included in this research study. After the endoscopic verification of bleeding ulcer and H. pylori status, the patients were treated with anti-secretory drugs, infusions and transfusions (when needed) and further with proton pump inhibitors, amoxicillin and clarithromycin (OAC) in standard doses. The control endoscopy was performed after 8 weeks, in order to verify the condition of ulcer and H. pylori status after eradication therapy. The eventual recurrence of peptic ulcer bleeding was followed during one year period in patients with H. pylori status.This study included 40 patients, of which 26 patients with bleeding duodenal ulcers and 14 patients with gastric bleeding ulcers. Their average age was 62.5. Out of the examined patients, 33 patients (or 82.5%) had positive result for H. pylori and 7 patients (or 17.5%) with negative H. pylori. After initiating and eradicating treatment, in 30 patients (or 91%) H. pylori eradication was successful and in 3 patients (or 9%) it was not successful. During an one-year follow-up, recurrent bleeding was reported in 4 out of 40 (or 10%) patients. In the group of H. pylori positive patients, re-bleeding occurred in 3 of 40 (or 7.5%), while in the group of patients with H. pylori negative, re-bleeding occurred in 1 out of 40 (or 2.5%) patients. After eradication, in the group with positive H. pylori, bleeding was reported in 3 of 3 (or 100%) of cases, whereas in the group with H. pylori negative patients, in 37 (or 2.7%) of cases. All three patients with positive H. pylori had recurrent hemorrhage (p \u3c0.05 and 0.01). The prevalence of infection with H. pylori in patients with bleeding from peptic ulcer was high (82.5%). The success of triple therapy in the eradication of H. pylori from bleeding ulcers was 91%. H. pylori eradication significantly reduced the number of recurrent bleeding from peptic ulcer, (p \u3c0.01). Detection of H. pylori infection in patients with peptic ulcer ulceration is of great importance

VDR Immunohistochemistry Expression Is Down-Regulated in Colorectal Cells of Patients with IBD and Could Rank the Patients According to Their Complications Risk

Background: Rising incidence of inflammatory bowel disease (IBD) is an increasing concern among patients of young age worldwide and its most important complication is colitis-associated cancer (CAC). Vitamin D (VD) deficiency is common in IBD and inversely associated with disease activity; meanwhile, vitamin D receptor (VDR) signaling in the gut protects the mucosal epithelial barrier and inhibits inflammation in the colon. This study aims to investigate the connection between VDR expression and IBD in human colorectal tissues. Research design and methods: Using a cross-sectional analysis, this study investigated VDR nuclear immunohistochemistry expression in 35 subjects. The expression level was measured in patients with IBD, and compared with healthy controls (cut off 36.29%). Results: VDR nuclear expression was significantly down-regulated in colorectal tissues of patients with IBD, compared with controls (p = 0.025). Under-expression of VDR was more remarkable in colon cells of patients with UC (p = 0.023). These results confirm the protective role of VD for colonic mucosa in human colon as well, and suggest a benefit from VD supplementation in IBD patients. Conclusions: Our findings add to the body of evidence regarding the positive effect of VD in colorectal mucosal integrity. This study contributes in establishing one of the proposed markers related to disease activity, which can also predict the risk for complications

A rare complication with superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy: A case report

Laparoscopic sleeve gastrectomy (LSG) has become a frequent procedure to reduce weight and morbid obesity. The procedure involves laparoscopic resection of more than 75% of the greater curvature of the stomach, resulting in early satiety and neuro-hormonal changes that collectively promote effective weight loss. We present a rare case of complication of superior mesenteric vein thrombosis (SMVT) and splenic vein after LSG, with consequent bowel ischemia that was treated with open laparotomy and appropriate anticoagulation therapy. A 56-year-old obese woman (BMI of 42.5 kg/m2), smoker for 30 years, presented to the emergency department with symptoms such as abdominal pain, fever, nausea and vomiting, 2 weeks after LSG intervention. Her white blood cell count was 15.5 (normal values: 3.8-10.4 × 103 /µL), while C- reactive protein level was 193 (normal values: 0.0-6.0 mg/L) and her D-Dimer level 4.69 (normal values: 0-0.50 mg/L). Abdominal CT with contrast showed a filling defect in the superior mesenteric and splenic vein, free perihepatic and Douglas pouch fluid, as well as small bowel thickening. An open laparotomy was performed and the necrotic segment of bowel of 80 cm was removed. The postoperative period went relatively well, despite the diarrhea that continued for the next 4 months after the intervention. The most common causes leading the development of this complication include: hypercoagulable state, dehydration, increased intra-abdominal pressure during the procedure and other secondary factors. The main symptom is abdominal pain, followed by nausea, vomiting, diarrhea and bleeding from the gastrointestinal tract. SMVT and SVT should be considered as a possible complication in patients with abdominal pain and increased inflammatory parameters after LSG. Early diagnosis through CT imaging and rapid anticoagulation therapy is considered to reduce further complications such as intestinal infarction and portal hypertension