The importance of morphological-clinical consistency: Through the review of gastric biopsies in north-eastern anatolia region in Turkey

AMAÇ: Çalışmamızda Türkiye'deki Kuzey-Doğu Anadolu bölgesindeki gastrik biyopsileri genel olarak gözden geçirmeyi amaçladık; malignite veya displazi yüzdeleri, biyopsi tekrarı önerilerinin nedenleri ve alınmışsa ikinci biyopsi sonuçları gibi. GEREÇ VE YÖNTEM: İki merkezde 3 patolog tarafından incelenen 1840 gastrik biyopsi geriye dönük olarak incelendi. Malignite veya displazi yüzdeleri, biyopsi tekrarı önerilen vakalar, önerilerin nedenleri ve yeniden alınan biyopsilerin sonuçları incelendi. İkinci biyopsi sonuçlarında displazi, malignite ve gastrit anlamlı sonuç olarak kabul edildi. BULGULAR: Olgularımızın yaş ortalaması 52.9 ± 16.6 yıl (18-95 yıl) idi. 1012 hasta (% 55) kadın, 828 hasta (% 45) erkekti. 1840 vakanın 90'ında, klinik olarak malignite şüphesi için biyopsi alındı. Bu olguların 35'i malignite olarak raporlandı. 1840 vakanın 61'ine biyopsi tekrarı önerildi. Yeniden biyopsi tavsiyelerinin sebepleri malignite şüphesi - klinik, malignite şüphesi - morfolojik ve yetersiz (yüzeyel) biyopsiler olarak üç gruba ayrıldı. İkinci biyopsi alınan 26 olgunun 12 'si (% 46.2) malignite ve gastrik displazi olarak bildirildi. 26 olgunun sadece 2'sinde (% 7.6) sonuç anlamlı değildi (yetersiz biyopsi). SONUÇ: Endoskopik bulgular tanı hakkında bilgi sağlarken, patognomonik değildir ve histolojik olarak onaylanması gerekir. Patolog ve gastroenterolog arasındaki iyi bir diyalog ve yakın çalışma ilişkisi, klinikmorfolojik tutarlılık, morfolojik-klinik tutarlılık ve nihai teşhis için önemlidir.OBJECTIVE: In our study we aimed to make a generally review of gastric biyopsies in North-Eastern Anatolia region in Turkey such as; percentages of malignancy or dysplasia, reasons of re-biopsy recommendations and results of second biopsies if taken. MATERIAL AND METHODS: 1840 gastric biopsies which examined by 3 pathologists at 2 centers were analyzed retrospectively. Percentages of malignancy or dysplasia, cases which were recommended for re-biopsies, reasons of recommendations and results of re-biopsies were examined. In the results of the second biopsies, dysplasia, malignancy and gastritis were accepted as a significant result. RESULTS: The mean age of our cases was 52.9 ± 16.6 years (range: 18-95 years). 1012 (55%) patients were females and 828 (45%) patients were males. In 90 out of 1840 cases, biopsies were taken for suspect of malignancy, clinically. 35 of 90 cases were reported as malignancy. In 61 out of 1840 cases re-biopsy were recommended. Reasons of recommendations for re-biopsy categorized in three groups: suspect of malignancy- clinically, suspect of malignancy- morphologically, insufficient (superficial) biopsies. 12 (46.2%) of 26 cases which were taken second biopsies were reported as malignancy and gastric dysplasia. Only in 2 (7.6%) of 26 cases the results were insignificant (insufficient biopsy). CONCLUSIONS: Endoscopic findings provide information about the diagnosis but are not pathognomonic which also need histological confirmation. Close working relationship and a good dialogue between the pathologist and the gastroenterologist is essential for clinical-morpological consistency, morphological-clinical consistency and final diagnosis

Anti-Mullerian hormone and insulin resistance in classic phenotype lean PCOS

Purpose This study is designed to explore the correlation between AMH levels and IR in normal weight PCOS women. Materials and methods This prospective study was conducted on 55 patients, who were admitted to obstetrics and gynecology department of a university clinic. Study group was consisted of 34 patients diagnosed as polycystic ovary syndrome (PCOS) according to the Rotterdam Criteria, whereas control group was consisted of 21 healthy volunteers without any features of clinical or biochemical hyperandrogenism, who had regular menstrual cycles. BMI C 25 kg/m2 were considered overweight and obese and excluded. Blood samples were obtained during days 2–3 after spontaneous menses or progesterone-induced withdrawal bleeding after overnight fasting for at least 12 h. The weight, height, hip and waist circumferences of the patients were measured. Fasting insulin and glucose (FPG) levels were used for calculating different insulin resistance indexes (Homeostatic Model Assessment (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI)). Results No significant difference was found between PCOS and control groups regarding the mean age, BMI, waist to hip ratio (WHR), mean values of FPG, FPG/insulin ratio and HOMA B (p[0.05). AMH values were significantly higher in PCOS cases when compared with controls (4.7 vs. 3.4 ng/mL) (p\0.05).The mean values of HOMAIR and QUICKI indexes were significantly higher among PCOS cases when compared with controls. E2 levels were significantly lower and Total-T were significantly higher in PCOS patients. When PCOS cases are categorized according to the existence of IR, no difference in Total-T and AMH levels between both groups. Although not statistically significant, a negative correlation of AMH with HOMA-IR and a positive correlation with QUICKI index were found. Among the hormone parameters, AMH was found to be positively correlated with Total-T (r = 0.332, p = 0.013). Conclusion Although the relation between AMH and androgen production is supported by current evidence, the mechanism underlying the relation between AMH and insulin resistance is not clear yet

PPI kullanımının clostridium difficile serum antijen değerlerine olan etkisi

Aim: To evaluate the effects of proton-pump inhibitor (PPI) use on distrubtion of intestinal flora by measuring serum Clostridium Difficile antigen levels before and at the end of a three- months treatment in patients with Laryngopharyngeal reflux (LFR) treatment. Material and Method: The study covers 32 patients with LFR, out of which 24 were female (75%) and 8 were male (25%). The mean age of the patients was 34.13 +/- 11.59. All patients included in the study were administered Lansoprazole 30 mg tablets perorally before meals and twice a day for treatment. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), white blood cell count, CRP and serum Clostridium Difficile toxin A, B measurement results were comparatively evaluated through the blood serum samples drawn from the patients before and at the end of the three- months treatment. Results: While the mean values of pre-treatment RSI and RFI were 20.81 +/- 4.05 and 13.31 +/- 3.30 respectively, the mean values were measured to be 3.41 +/- 2.37 and 1.50 +/- 1.88 respectively following the three- months treatment (p< 0.05). The pre-treatment mean value of serum Clostridium Difficile Ag was 140.56 +/- 11.74, while it was seen that the same value became 114.94 +/- 10.70 after the three- months treatment (p< 0.05). There was, however, no statistically significant change in the other parameters. Discussion: According to the results obtained, it was seen that the treatment with PPI was not cause to increase Clostridium difficile toxin A, B serum antigen levels. So these drugs could be used in long time therapies confidently.Amaç: Larengofarengeal Reflü (LFR) hastalığının tedavisi amacıyla Proton pompa inhibitörü (PPİ) kullanan hastalarda tedavi öncesi ve üç aylık tedavinin sonunda serum Clostridium Difficile antijen miktarı ölçülerek PPİ kullanımının serum Clostridium Difficile serum antijen miktarı üzerindeki etkisinin değerlendirilmesi. Gereç ve Yöntem: Çalışmaya LFR hatalığı tespit edilen 32 hasta ( 24 ( % 80)’ü kadın, 8 (% 20)’i erkek) dahil edildi. Hastaların yaş ortalaması 34.13 ± 11.59 idi. Çalışmaya dahil edilen tüm hastalara tedavi için günde iki kez yemeklerden önce alınacak şekilde lansoprazol 30 mg tablet peroral olarak başlandı. Tedavi öncesinde ve üç aylık tedavinin sonunda hastaların LFR şiddeti Reflü Semptom İndeksi ( RSI) ve RBS ( Reflü Bulgu Skoru) kullanılarak değerlendirildi. Ayrıca hastalardan tedavi öncesi ve üç aylık tedavinin sonunda alınan kan serum örneklerinde beyaz küre, CRP, sedimantasyon ve serum Clostridium Difficile toxin A, B ölçümleri yapılarak karşılaştırmalı olarak değerlendirildi. Bulgular: Tedavi öncesi RSI ve RBS ortalamaları sırasıyla 20.81±4.05 ve 13.31±3.30 iken, üç aylık tedavi sonrasında bu ortalamalar sırasıyla 3.41±2.37 ve 1.50±1.88 olarak tespit edildi ( p< 0,05). Tedavi öncesi serum Clostridium Difficilie Ag değerlerinin ortalaması 140.56±11.74 iken üç aylık tedavi sonrasında bu ortalamanın 114.56±10.70 olduğu görüldü ( p 0,05). Tartışma: Elde ettiğimiz sonuçlara göre, proton pompa inhibitörü kullanan hastaların Clostridium difficilie toxin A, B serum antijen düzeylerinde istatistiksel olarak anlamlı bir düşüş olduğunu görüldü

The impact of route of anesthesia on maternal and fetal ischemia modified albumin levels at cesarean section: a prospective randomized study

Objective: Ischemia modified albumin has been shown to increase in ischemic situations, and has also been shown to increase in fetal cord blood in deliveries by cesarean section. The aim of this study is to reveal whether anesthesia has an impact on maternal and fetal cord ischemia modified albumin levels. Methods: Seventy two women with uncomplicated term pregnancies were randomized to spinal (n = 37) or general anesthesia (n = 35) groups. The blood pressure, oxygen saturation, and pulse rate of the patients were recorded during the procedure. Maternal blood samples of ischemia modified albumin (IMA) were taken 10 min from the start of the procedure. The fetal cord blood samples of IMA were taken immediately after birth. Results: Maternal (0.99 ± 0.19 vs. 0.80 ± 0.27) and fetal (1.00 ± 0.21 vs. 0.70 ± 0.26) IMA levels were significantly higher in the general anesthesia group. Fetal IMA levels were positively correlated with maternal gravidity (r = 0.31; P = 0.008), parity (r = 0.25; P = 0.028), and fetal birth weight (r = 0.23, P = 0.045). Also, as time from incision to delivery lengthens, fetal IMA levels increase (r = 0.29, P = 0.012). Conclusion: Fetal cord ischemia modified albumin levels were higher in the general anesthesia group, therefore, it is proposed that regional anesthesia should be the preferred route of anesthesia for an elective cesarean section, at least until the impact of high fetal cord IMA levels are manifested

Atherogenic dyslipidemia, subclinical atherosclerosis, non-alcoholic fatty liver disease and insulin resistance in polycystic ovarian syndrome

Objective: We aimed to explore the relationship between insulin resistance (IR) and small dense lipoprotein (sd-LDL) particles, carotid intima-media thickness (CIMT) and non-alcoholic fatty liver disease (NAFLD) in young normal weight PCOS cases. Methods: This prospective, case-control study was designed in a University Hospital and 34 women with PCOS and 21 healthy controls were enrolled. Fasting plasma glucose, insulin, lipid (including sd-LDL particles) and hormone profiles, abdominal ultrasound and CIMT were evaluated. Results: IR was present in 68% of PCOS group while in none of controls. High density lipoprotein (HDL), very low density lipoprotein (VLDL), triglycerides (TG), and sd-LDL were higher in patients with IR (p<0.05). A positive correlation of sd-LDL with IR, VLDL and TG was found. A significantly higher rate of NAFLD and CIMT was found in PCOS. Totaltestosterone levels were weakly and positively correlated with CIMT (r=0.277, p=0.041). Conclusion: Insulin resistance and NAFLD are highly prevalent among young normal weight PCOS patients. When compared to controls levels of sd-LDL and CIMT are increased in PCOS. Insulin resistance is the key parameter for NAFLD and atherogenic dyslipidemia in PCOS. Hence, screening for NAFLD may be valuable for detection and prevention of liver disease. Higher levels of sd-LDL in insülin resistant PCOS cases necessiates treating PCOS for I

Gebelik döneminde hba1c ve fruktozaminin glisemik kontrol belirteci olarak önemi ve bazı biyokimyasal paramatrelerin değerlendirmesi

[No Abstract Available

Gebelik döneminde hba1c ve fruktozaminin glisemik kontrol belirteci olarak önemi ve bazı biyokimyasal paramatrelerin değerlendirmesi

Amaç: Diyabetin kontrol ve monitorizasyonu fetal malformasyon, makrozomi ve diğer komplikasyonlar nedeniyle gebelikte özellikle önemlidir. Çalışmamız, monitorizasyonda en sık kullanılan iki parametre olan hemoglobin A1c (HbA1c) ve fruktozaminin gebelik döneminde güvenilirliğinin araştırılması amacıyla tasarlanmış; ayrıca çalışma gruplarımızda serum total protein, albümin, vitamin B12, folat, glukoz, insülin, ferritin ve hemoglobin verileri de değerlendirilmiştir. Metod: Çalışma grupları; ek sağlık problemi olmayan gebeler (n=252; ort. yaş: 27,761± 5/ yıl) ve kontrol grubu (n=28; ort. yaş: 28,61± 5,38/yıl)’ndan oluşmuştur. Diyabetik gebe grubu 124 (10’u ilk, 62’si ikinci ve 52’si üçüncü trimestrde); nondiyabetik gebe grubu ise 138 kişiden (24’ü ilk, 32’si ikinci ve 82’si üçüncü trimestrde) oluşmuştur. Bütün ölçüm verileri hastane bilgi sisteminden sağlanmıştır. Bulgular: Grupların hiçbirinde HbA1c için istatistiksel olarak anlamlı fark bulunamamıştır. Fruktozamin için bulunan anlamlı farkların da albümine bağlı olarak oluştuğu net olarak görülmüş ve fruktozamin düzeyleri trimestrler boyunca progresif olarak azalmıştır. Diyabetik gebe grubumuzda elde ettiğimiz ortalama kan şekeri değeri diğer gruplara kıyasla istatistiksel olarak fark yaratsa da beklentimizin altında kalmıştır. Sonuç: Çalışmamızda gestasyonel diyabet tanı ve takibinde HbA1c ve fruktozaminin yeterli bir belirteç olmadığı sonucuna varılmıştır. Ancak fruktozamin ve HbA1c düzeylerinde gruplar arasında fark bulunmaması ve diyabetik gebe grubumuzda beklentimizin altında kalan kan şekeri düzeylerinin iyi diyabet kontrolüne bağlı olabileceği de olasılıklar arasındadır.Objective: Controlling and monitoring the diabetes during pregnancy, because of the malformation, macrosomia and other complications is especially important. Our study is designed to investigate the reliability of the two most commonly used parameter is the hemoglobin A1c (HbA1c) and fructosamine during pregnancy. Also among our study group, serum total protein, albumin, vitamin B12, folic acid, glucose, insulin, ferritin and hemoglobin data were evaluated. Methods: The study groups are pregnant women (n=252; age mean: 27,761± 5/year) and control group (n=28; age mean: 28,61± 5,38/year) who are no additional health problems. Diabetic pregnant women number is 124 (consisted of 10 first trimester, 62 second trimester and 52 third trimester) and nondiabetic pregnant women number is 138 (consisted of 24 first trimester, 32 second trimester and 82 third trimester). All measurement data are obtained from hospital information system. Results: No statistically significant difference in any of the groups for HbA1c. It’s clearly observed that all the significant differences found for fructosamine occur depending on the level of albumin and fructosamine levels decreased progressively during the three trimesters. In our diabetic pregnant women group; although statistically make a difference; mean blood glucose values were below our expectations. Conclusion: Our study is support that fructosamine and HbA1c are unavailable for diagnosis and monitoring the gestational diabetes. However the lack of difference between the groups for levels of fructosamine and HbA1c; and blood glucose levels below our expectations in diabetic pregnant women group can be connected good diabetes control