Lymphocytic Colitis Associated with Lansoprazole Treatment

AbstractIntroduction: There have been several reported cases of lansoprazole-associated collagenous colitis (CC) reported in the literature but only 1 reported case of lansoprazole-associated lymphocytic colitis (LC) in the literature. Both CC and LC are considered inflammatory bowel diseases, but they are distinctly classified based on the condition of the colon, which is typically confirmed through biopsy.Case summaries: A 52-year-old white male (Patient 1), with a height of 178 cm and weight of 75 kg, presented to Gazi University Hospital, Ankara, Turkey, with a 3-month history of abdominal pain and nonbloody, watery diarrhea. The patient reported receiving PO lansoprazole 30 mg/d to treat heartburn ~1 week prior to the onset of diarrhea. The patient's medical history revealed that he did not have any preexisting conditions, other than gastroesophageal reflux disease (GERD) for which lansoprazole was prescribed. The medical history report also revealed that the patient was not receiving any concomitant medications or treatments at the time. A colon biopsy confirmed LC. Additionally, a 43-year-old white female (Patient 2), with a height of 168 cm and weight of 61 kg, presented to the same facility with a 6-month history of nonbloody, watery diarrhea and mild lower abdominal cramping. The patient reported that initial onset began ~2 months after receiving a 10-day Helicobacter pylori eradication combination treatment regimen that included lansoprazole, amoxicillin, and clarithromycin, followed by lansoprazole monotherapy to treat GERD. The patient's medical history revealed no other concomitant medications were being adminstered at the time. A colon biopsy confirmed LC.Discussion: A search of the literature using the MEDLINE database and all relevant English-language articles with key words lansoprazole and lymphocytic colitis, found that there were several cases of lansoprazole-associated CC reported and 1 reported case of lansoprazole-associated LC. Histologic findings from laboratory tests and colon biopsies confirmed diagnoses of LC in both patients in this case report. Patient 1 presented with diarrhea and cramping, which the patient reported had been ongoing for ~3 months, following lansoprazole administration. However, after lansoprazole was discontinued, the symptoms completely resolved within 7 days. Patient 2 presented with diarrhea and cramping, which had been occurring for ~6 months. That patient reported that initial onset commenced ~2 months after a 10-day H pylori eradication combination treatment regimen that included lansoprazole, amoxicillin, and clarithromycin, followed by lansoprazole monotherapy to treat GERD. However, after sulfasalazine (3 g/d) was prescribed for 2 months immediately upon diagnosis of LC, there was little improvement in the effort to control the diarrhea in this patient. After omeprazole 20 mg/d was substituted for lansoprazole, the patient's diarrhea ceased. Follow-up sigmoidoscopy 2 months later revealed normal mucosa and complete normalization of histologic findings. The patient remains diarrhea-free while on omeprazole. A causality assessment using the Naranjo adverse reaction algorithm produced scores of 6 for both patients, suggesting that LC was probably associated with lansoprazole treatment.Conclusions: Here we report 2 cases of LC in patients probably associated with the administration of lansoprazole treatment. Complete remission occurred after lansoprazole was discontinued

Two-detector Computed Tomography Map of the Inferior Epigastric Vessels for Percutaneous Transabdominal Intervention Procedures

Background:It is crucial to know anatomic variations and the exact course of an inferior epigastric artery (IEA) to prevent any complica-tions during percutaneous abdominal interventions. Aims:The aim of this study was to map the inferior epigastric ves-sels using reconstructed two-detector computed tomography images and measure the distance from the inferior epigastric artery (IEA) to the midline to determine a safe route for percutaneous abdominal interventions. Study Design: Retrospective comparative study.Methods:Coronal reconstructed two-detector computed tomogra-phy images of 200 patients were evaluated to measure the distances between the IEA and midline at three levels (origin, middle, and dis-tal). Vein and artery arrangements were documented.Results:The most frequently encountered arrangement (41.5%) was a single vein and artery on both sides. Mean distances on the right and left sides were 4.01 and 4.47 cm at the umbilical level, 3.81 and 4.26 cm at the midlevel, and 5.62 and 5.51 cm at the origin level. On both sides, measurement differences between the three levels were highlysignificant (p<0.05). In addition, a total of 56 IEA bifurcations were depicted in all 200 patients. Thirteen of the 56 bifurcations occurredonly on the right side, 11 only on the left side, and 32 on both sides.Conclusion:It is important to be attentive to the IEA's course, at different midline levels, when attempting percutaneous interventions via an abdominal approach

Vieussens’ arterial ring: a rare coronary variant anatomy

PURPOSEWe aimed to evaluate Vieussens’ arterial ring (VAR) variants by consecutive coronary computed tomography (CT) angiography examinations.METHODSWe retrospectively evaluated the presence of VAR in a total of 3443 consecutive coronary CT angiography examinations performed between November 2010 and January 2015. CT examinations were performed with a 64-row multidetector computed tomography (MDCT) scanner. All CT angiography images were evaluated for the presence and morphologic features of VAR subtypes. VAR variants were classified into four subgroups.RESULTSEleven VAR variations (3.19‰) were identified. Type 1A was the most common VAR type (n=8), followed by Type 2 (n=2) and Type 3 (n=1). Type 1B was not detected.CONCLUSIONAlthough VAR variation is less frequently detected with coronary CT angiography than in previously reported anatomic series, coronary CT angiography is quite effective to reveal VAR subtypes and other relevant cardiocoronary anomalies

MITOCHONDRIAL DNA COPY NUMBER IS ASSOCIATED WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

Background: Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in children. Several hypotheses have been proposed to explain its etiology. Mitochondrial dysfunction (MD) is suggested to be one of the causes of Attention Deficit Hyperactivity Disorder. The objective of the study was to evaluate the relationship between MD and ADHD by investigating mitochondrial DNA (mtDNA) levels from peripheral blood leukocytes, one of the best biomarkers of mitochondrial dysfunction. Subjects and methods: This study included 56 children aged 6-16 years who were diagnosed with ADHD for the first time and 56 age- and sex matched children without ADHD. Real-time PCR was performed to determine the relative mtDNA copy number in each study participant. Results: The mean mtDNA copy number of the case group was 57.623±24.827 and that of the control group was 44.204±18.926 (p=0.002). The mtDNA copy number of the case group was higher than that of the control group. Results of ROC curve analysis provided a mtDNA cutoff value of 45. Conclusion: Significantly higher mtDNA copy number in ADHD group may suggest mitochondrial dysfunction in the etiopathogenesis of ADHD

EVALUATION OF A GROUP OF EPILEPSY PATIENTS IN TERMS OF SLEEP QUALITY, FATIGUE AND DEPRESSION

Introduction: The aim of this study is to investigate the relationship between clinical features, sleep quality, fatigue and mental symptoms in epileptic patients. Material and Methods: This cross-sectional study was conducted at epilepsy outpatient clinic of Bozyaka Training and Research Hospital. 81 patients who were followed up for the diagnosis of epilepsy were included in the study. The patients were administered a sociodemographic data form, Pittsburgh Sleep Quality Index, Beck Depression Inventory, Fatigue Severity Scale. Results: The median age of the patients included in the study was 37.42 (51.9%) were women and 39 (48.1%) were men with a education period of 8 years. There was no previous family history of psychiatric illness. Seizure control was achieved in 34 (42%) patients. 53 (65.4%) patients were observed for focal type, 28 (34.6%) patients were for generalized type seizures. The median duration of epilepsy was 13 years. The median Beck Depression Inventory score of the patients was 13, and the number of patients with a Beck Depression Inventory score higher than 19 was 25 (30.9%). There was mild tiredness in 47 (58%) and chronic fatigue in 16 (19.8%) patients. The median of Pittsburgh Sleep Quality Index total score was 4 and 18.5% (15) had poor sleep quality. Chronic fatigue was higher in epilepsy patients without seizure control compared to those with seizure control (p = 0.001). Conclusion: The rate of patients with moderate and severe depression is high in our study. This indicates the significance of evaluating the diagnosis of depression in epilepsy patients. In the follow-up of these patients, it is crucial to investigate the causes of fatigue and depression carefully. Especially psychiatric expert opinion and multidisciplinary follow-up should be carried out without ignoring the presence of depression

Impairment of the left ventricular systolic and diastolic function in patients with non-alcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is considered the liver component of the metabolic syndrome. We investigated the diastolic and systolic functional parameters of patients with NAFLD and the impact of metabolic syndrome on these parameters. Methods: Thirty-five non-diabetic, normotensive NAFLD patients, and 30 controls, were included in this study. Each patient underwent transthoracic conventional and tissue Doppler echocardiography (TDI) for the assessment of left ventricular (LV) diastolic and systolic function. Study patients were also evaluated with 24-hour ambulatory blood pressure monitoring. Results: NAFLD patients had higher blood pressures, increased body mass indices, and more insulin resistance than controls. TDI early diastolic velocity (E&#8217; on TDI) values were lower in NAFLD patients than the controls (11.1 &#177; 2.1 vs 15.3 &#177; 2.7; p < 0.001). TDI systolic velocity (S&#8217; on TDI) values were lower in NAFLD patients than the controls (9.34 &#177; 1.79 vs 10.6 &#177; 1.52; p = 0.004). E&#8217; on TDI and S&#8217; on TDI values were moderately correlated with night-systolic blood pressure, night-diastolic blood pressure, and night-mean blood pressure in NAFLD patients. Conclusions: Patients with NAFLD have impaired LV systolic and diastolic function even in the absence of morbid obesity, hypertension, or diabetes. (Cardiol J 2010; 17, 5: 457-463

Successful Treatment of Herpes Esophagitis With Ganciclovir in a Liver Transplant Patient

The presence of Herpes Simplex Virüs-1 (HSV-1) esophagitis in patients with liver transplantation has been reported rarely. Among the reports that are accessible in the literature, none could have shown tissue positivity for Herpes virus-1 DNA via Polymerase Chain Reaction (PCR) in patients with liver transplantation. This case is presented as the patient was diagnosed with herpes esophagitis based on the histopathological findings and HSV-1 DNA positivity (detected by PCR) in the biopsy material and was treated with Ganciclovir. Due to the specific action of Ganciclovir against CMV infections, it is natural that the drug cannot use in the treatment of HSV infections. However it is reported that ganciclovir has been reduced the incidence of symptomatic HSV infections after liver transplantation. We report on a patient after liver transplantation with HSV-1 esophagitis, who was successfully treated with Ganciclovir. We assume that most transplant centers according to their protocols use ganciclovir for CMV prophylaxis, which may contribute to avoid HSV infection

PNEUMOTHORAX IN NEWBORN: OUR EXPERIENCE

Amaç: Yenidoğan döneminde solunum sıkıntısı yapan nedenlerden biri de pnömotoraks olup, mekanik ventilasyon tedavisi, mekonyum aspirasyonu sendromu, solunum güçlüğü sendromu ve perinatal asfiksi nedeniyle canlandırma işlemi uygulanan olgularda gelişme riski yüksektir. Hastanemiz yenidoğan bakım ünitesinde semptomatik pnömotoraks saptanarak tedavi edilen olgular geriye dönük olarak incelenmiştir. Gereç ve yöntem: Ocak 2003-Ocak 2006 tarihleri arasındaki 7 pnömotorakslı olguda gestasyonel yaş, ağırlık, aminon sıvısının mekonyumla boyalı olup olmadığı, primer akciğer patolojisi varlığı ve pnömotoraksın tarafı değerlendirildi. Tanıda akciğer grafisi ve bazı olgularda konjenital anomali varlığını araştırmak için bilgisayarlı tomografi yapıldı. Toraks drenaj işlemi için 10 F tüp kullanıldı. Bulgular: 7 olgunun değerlendirilmesinde; pnömotoraks insidansı %1,2 (7/570), erkek kız oranı 1,3, başvuru zamanı 10 saat ile 6 gün idi. 5 hasta (%71,4) prematürdü. Pnömotoraks sağda 3 (%42,9), bilateral 4 (%57,1) vakada mevcuttu. Serimizde mortalite % 57,1 olarak bulunmuştur. Vefat eden olguların büyük bir kısmı (%75) prematüre, solunum güçlüğü sendromlu ve iki taraflı pnömotoraksı olan olgulardı. Sonuç: Yenidoğan pnömotoraks olgularında mortalitenin prematürite, SGS ve iki taraflı pnömotoraks varlığında yüksek olması literatür ile uyumlu bulundu. Objective: Pneumothorax is one of the important etiologic factors in newborn which causes respiratory distress. Pneumothorax usually occurs in newborns under mechanical ventilation. Respiratory distress syndrome, meconium aspiration syndrome and resuscitation after birth may also cause pneumothorax. We retrospectively reviewed patients who were hospitalized for pneumothorax in our newborn intensive care unit. Material and method: Between January 2003 and January 2006, 7 cases were treated for pneumothorax. These cases were analyzed according to gestational age, existence of meconium in the amniotic fluid, primary lung pathology, weight, and side of pneumothorax. The relation between these criteria and the mortality was investigated. 10 F tube were used for thoracostomy. The diagnosis was made by chest x-rays, computerized tomography was used to examine presence of congenital anomalies. Results: The incidence of pneumothorax in the neonates treated in our intensive care unit is found to be 1,2 % (7/570). M:F ratio was 1.3. Age of admittance ranged from 10 hours to 6 days. Five patients (71,4) were premature. Pneumothorax was present at right hemithorax in 3 (42,9%) while 4 patients (%57,1) were bilaterally affected. Mortality rate was 57,1%. Most of the patients who died were premature (75%) and had bilateral pneumothorax. Conclusion: Also seen in the literature, we found that the mortality rate was higher in premature, RDS patients and the patients who had bilateral pneumothorax