Preoperative detection of insulinomas: two case reports

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Kolorektal kanser tanısında insülin benzeri büyüme faktörü-1 (IGF-1) ve insülin benzeri büyüme faktör bağlayıcı protein-3 (IGFBP-3)’ün kullanılabilirliği

İnsülin benzeri büyüme faktörü-1 (IGF-1), etkisi insülin benzeri büyüme faktör bağlayıcı protein-3 (IGFBP-3) tarafından düzenlenen, potent bir mitojen ve antiapoptotik ajandır. IGFBP-3, IGF-1’i dolaşımda taşır, hedef dokulara yönlendirir, onu proteolitik degradasyondan korur. IGFBP-3 in vitro şartlarda kolon kanser hücrelerinin tümörojenik potansiyellerini azaltır. IGFBP-3 hedef hücreleri doğrudan inhibe edebilir. Çalışmamızda kolorektal kanserli hastalarda IGF-I, IGFBP-3’ün tümör markırı olarak kullanılıp, kullanılamayacağı ve bilinen tümör markırlarından karsinoembriyonik antijen (CEA), karbonhidrat antijeni 19-9 (CA19-9) ile olan ilişkisi incelendi. Çalışmamıza histopatolojik olarak kolorektal kanser teşhisi konulmuş 40 hasta ile, kontrol grubu olarak benzer yaş grubundan ve tamamen sağlıklı 40 kişi dahil edildi. Kontrol grubu ile kıyaslandığında kolorektal kanserli hastalarda IGF-I düzeyi anlamlı derecede yüksek bulundu (p< 0.01). IGFBP-3 düzeyleri kolorektal kanserde kontrol grubu ile kıyaslandığında anlamlı derecede düşük bulundu (p< 0.05). Yine aynı vakalarda çalışılan CEA ve CA19-9 düzeylerinde gözlenen artış kontrol grubu ile kıyaslandığında istatistiki açıdan anlamlı olarak yüksek bulundu (p< 0.05). Fakat IGF-1 ve IGFBP-3 düzeylerindeki değişimi ile CEA ve CA 19-9 arasında anlamlı ilişki tespit edilemedi. Sonuç olarak, IGF-I düzeyindeki artış, kolorektal kanser şüphesi olan hastalarda tümör varlığı yönünden anlamlı bir gösterge olarak kabul edilebilir. IGFBP-3 düzeyini artışına neden olabilecek ajanlar kolorektal kanser tedavisinde yeni ufuklar açabilir.Insulin-like growth factor (IGF-1) is a potent mitogen and an anti-apoptotic agent which is regulated by insulin-like growth factor binding protein-3 (IGFBP-3). IGFBP-3 carries IGF-1 through the bloodstream to the target tissues and protects it from proteolytic degradation. IGFBP-3 reduces tumorigenic potential of colon cancer cells in vitro. IGFBP- 3 may inhibit target cells directly. In the present study, we assessed whether serum levels of IGF-I and IGFBP-3 could be used as tumor markers in patients with colorectal cancers and evaluated its relationship with known tumor markers, carcinoembryogenic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). Our study enrolled 40 patients diagnosed with colorectal cancer histopathologically and 40 completely healthy, agematched subjects (control group). Serum IGF-I levels were found significantly higher in patients with colorectal cancers compared to control group (p< 0.01). Serum IGFBP-3 levels were significantly lower in patients with colorectal cancers compared to control group (p< 0.05). The observed increase in CEA and CA19-9 levels in the same subjects were found statistically significantly higher compared to control group (p< 0.05). However, no significant association could be found between change in IGF-1 and IGFBP-3 levels and CEA or CA 19-9. Increased serum levels of IGFI might be considered as a significant predictor of tumor presence in patients with suspected colorectal cancer. Agents that could increase IGFBP-3 levels might be promising for the treatment of colorectal cancers

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study

WOS: 000561377700019PubMed: 32904611Introduction: Interventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. the most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aim: To compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP. Material and methods: Forty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 mu g/kg for 10 min) in group D. Propofol was used for maintenance. the sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded. Results: the hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 +/- 80.0 vs. 154.5 +/- 66.7 mg; p = 0.011). the recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 +/- 2.1 vs. 6.6 +/- 1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups. Conclusions: We found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients

Serum cystatin C measurement in differential diagnosis of intra and extrahepatic cholestatic diseases

Objective. Cystatin C is a very potent inhibitor of cysteine proteinases and, it has been clinically applied as a sensitive marker in monitoring of renal and liver functions. The aim of this study was to reveal whether cystatin C may be a useful marker for distinguishing intra-versus extrahepatic cholestasis.Materials and methods. Serum cystatin C concentrations were determined by nephelometric immunoassay using N latex cystatin C kit in 53 patients with cholestatic disorder that included 18 patients with intrahepatic cholestasis, 17 patients with malignant extrahepatic cholestasis, 18 patients with benign extrahepatic cholestasis. Serum cystatin C concentration was also determined in 20 healthy volunteers.Results. Mean serum cystatin C concentration was 2.82 ± 0.24 mg/l (SD) in patients with intrahepatic cholestasis, 2.05 ± 0.15 mg/l in patients with extrahepatic malignant cholestasis, 1.37 ± 0.13 mg/l in extrahepatic benign cholestatic patients and 0.93 ± 0.24 mg/l in control group. Serum cystatin C concentrations in patients with cholestatic disease were significantly higher than those in the healthy controls (p < 0.001). Moreover, mean serum cystatin C concentration in patients with intrahepatic cholestasis was higher than those in extrahepatic cholestasis groups (p < 0.001). Serum cystatin C concentrations were significantly higher in patients with malignant extrahepatic cholestasis than in patients with benign extrahepatic cholestasis (p < 0.001). There were no correlations patients among serum cystatin C concentrations and serum levels of AST, ALT, ALP, GGT, total and conjugated bilirubin.Conclusion. Our results suggested that serum cystatin C level may be a potential biochemical marker both to point out an intrahepatic origin by excluding an extrahepatic source of cholestasis in patients with jaundice and to possibly differentiate bening and malignant extrahepatic cholestatic disorders

Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.status: publishe

Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.SCOPUS: ar.jinfo:eu-repo/semantics/publishe