Hepatit B’ye Bağlı Kronik Karaciğer Hastalığında Safra Kesesi Motilitesinin Değerlendirilmesi

Amaç: Çalışmamızda hepatit B’ye bağlı kronik karaciğer hastalarında portal hipertansiyonla ilişkili faktörlerin safra kesesi duvar kalınlığı ve motilitesi üzerindeki etkilerine bakıldı. Aynı zamanda antrum duvar kalınlığı ve mide motilitesi üzerindeki etkilerine bakılması amaçlandı. Yöntemler: Çalışmaya portal hipertansiyon bulguları olmayan 10 hasta kontrol, portal hipertansiyon gelişmiş 20 hasta olgu grubu olarak alındı. Batın ultrasonografiyle açlık, test yemeği sonrası 15.dk, 30.dk, 60.dk, 90.dk, 120.dk safra kesesi ve antrum duvar kalınlığı, postprandiyal safra kesesi volümleri ve ejeksiyon fraksiyonları ölçüldü. Bulgular: Hastaların 15’i Child Pugh A (%50), 10’u Child Pugh B (%35), 5’i Child Pugh C (%15) olarak sınıflandırıldı. Her iki grupta zamanla safra kesesi ejeksiyon fraksiyon oranlarının arttığı, safra kesesi volümlerin de azalma olduğu gösterildi. Sirozlu hastaların safra kesesi duvar kalınlık değişimi kontrol grubuna göre 30 ve 90. dk’ larda istatistiksel anlamlı ölçüde arttığı gösterildi. Sirozlu hastalarda antrum duvar kalınlığındaki değişim oranının 15, 30. ve 120. dakikalarda istatistiksel olarak anlamlı şekilde arttığı gösterildi. Sonuç: Kronik karaciğer hastalığında safra kesesi duvar kalınlığında artma ve motilitesinde azalma olduğu saptandı. Bu sonuçlardan portal hipertansiyonun tek başına sorumlu olmadığı gösterildi. Portal hipertansiyon olan ve olmayan kronik karaciğer hastalarında safra kesesi hipomotilitesi yönünden bir fark olmadığı saptandı. Safra kesesi hipomotilitesi ve kese duvar kalınlaşmasında portal hipertansiyonla ilişkili karaciğer yetmezliğine bağlı rezervin azalması, hipoalbuminemi, safra stazı bilinen önemli nedenlerdir. Ancak portal hipertansiyon dışı nörohumoral faktörlerin de sorumlu olabileceğini düşündürdüğünden bununla ilgili ileri çalışmaların yapılması gerektiğini düşünmekteyiz.Objective: In our study, the effects of factors related to portal hypertension on gallbladder wall thickness and motility in chronic liver patients due to hepatitis B were investigated. At the same time, it was aimed to investigate the effects on antrum wall thickness and stomach motility. Method: 10 patients without portal hypertension findings were included in the study as control and 20 patients with portal hypertension were included as the case group. The gallbladder and antrum wall thickness, postprandial gallbladder volumes and ejection fractions were measured by abdominal ultrasonography, 15 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes after the test meal. Results: 15 of the patients were classified as Child Pugh A (50%), 10 as Child Pugh B (35%), 5 as Child Pugh C (15%). It was shown that ejection fraction rates increased and gall bladder volumes decreased in time in both groups. It was shown that gallbladder wall thickness change in cirrhotic patients increased statistically significantly at 30 and 90 minutes compared to the control group. It was shown that the rate of change in antrum wall thickness in patients with cirrhosis significantly increased at 15, 30 and 120 minutes. Conclusion: Increased gallbladder wall thickness and decreased motility were found in chronic liver disease. It has been shown that portal hypertension alone is not responsible from these results. It was found that there was no difference in terms of gall bladder hypomotility in chronic liver patients with and without portal hypertension. In gallbladder hypomotility and bladder wall thickening, decreased reserve due to liver failure associated with portal hypertension, hypoalbuminemia, and bile stasis are known important causes. However, we think that further studies should be carried out, as it suggests that neurohumoral factors other than portal hypertension may also be responsible

A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst

Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI), a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst

The comparison of the intestinal adaptation effects of subcutaneous and oral insulin in a rats with short bowel syndrome

Aim: Insulin has been reported to have positive effects on intestinal adaptation after short bowel syndrome when applicated oral or subcutaneously. The purpose of this study is to compare the intestinal adaptation effects of subcutaneous and oral routes of insulin in rats with short bowel syndrome. Materials and Methods: The short bowel syndrome (SBS) was performed through 70-75% of small intestinal resection and an end-to-end anastomosis. The control group rats underwent SBS only. In the second group, oral insulin (1 U/ml) was administrated twice-daily. In the last group, the insulin was administrated subcutaneously (1 U/kg) as in the control group. All rats were killed on day 15. Outcome parameters were weight of small intestine, the crypt length, villous depth, the blood levels of vascular endothelial growth factor (VEGF), and granolocyt-monocyst colony-stimulating factor (GMCSF). Results: Intestinal weight was significantly more in oral insulin group and subcutaneous insulin group than in the control group (72.6 ± 4.3, 78.6 ± 4.8 and 59.7 ± 4.8) (P 0.05). VEGF values were not statistically significant between the groups (200.3 ± 41.6, 178.9 ± 30.7 and 184.3 ± 52.2) (P > 0.05). GMCSF was statistically higher in the control group than in other groups (3.34 ± 1.34, 1.56 ± 0.44 and 1.56 ± 0.44) (P < 0.05). Conclusion: Insulin has positive effects on intestinal adaptation in short bowel syndrome. Subcutaneous administration is slightly more effective than the oral route

Serum Paraoxonase 1 Activity Predicts Arterial Stiffness in Renal Transplant Recipients

WOS: 000297673000008PubMed ID: 21737961Aim: Paraoxanase 1 (PON 1) has been shown to protect against atherosclerosis by modifying lipoproteins. Its activity decreases in dialysis patients but is restored after transplantation. Whether it affects arterial stiffness is unclear. In this study we aimed to investigate the effects of PON 1 on arterial stiffness in renal transplant patients. Methods: Seventy renal transplant recipients were enrolled. Arterial stiffness was measured using a Syphmocor device. PON-1 activity was assessed from the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.0 +/- 9.6 years and 5.7% of the patients were diabetic. Post-transplant follow-up time was 46.7 +/- 37.9 months. Eighty-five percent received anti-hypertensive and 12.9% anti-hyperlipidemic medication. Mean PON1 activity was 75.9 +/- 52.4 U/L. PON1 activity was negatively correlated with systolic and diastolic blood pressure, mean arterial pressure, LDL-cholesterol and carotid-femoral pulse wave velocity (cf-PWV). Mean c-f PWV was 8.10 +/- 1.39 m/s. Cf-PWV was positively correlated with age, systolic and diastolic blood pressure, mean arterial pressure, proteinuria and negatively correlated with PON1, PON1/HDL ratio and creatinine clearance. In linear regression analysis, PON1 was a predictor of cf-PWV in a model that included age, gender, diabetes, mean arterial pressure, urine protein level, creatinine clearance and PON 1. Conclusions: Reduced PON1 activity is significantly associated with increased arterial stiffness. The results of this study show the possible role of PON1 for arterial stiffening in renal transplant recipients

Anti-stress and anti-anxiety effects of centrally acting angiotensin II AT\u3csub\u3e1\u3c/sub\u3e receptor antagonists

The brain and the peripheral (hormonal) angiotensin II systems are stimulated during stress. Activation of brain angiotensin II AT1 receptors is required for the stress-induced hormone secretion, including CRH, ACTH, corticoids and vasopressin, and for stimulation of the central sympathetic activity. Long-term peripheral administration of the angiotensin II AT 1 antagonist candesartan blocks not only peripheral but also brain AT1 receptors, prevents the hormonal and sympathoadrenal response to isolation stress and prevents the formation of stress-induced gastric ulcers. The mechanisms responsible for the prevention of stress-induced ulcers by the AT1 receptor antagonist include protection from the stress-induced ischemia and inflammation (neutrophil infiltration and increase in ICAM-1 and TNF-α) in the gastric mucosa and a partial blockade of the stress-induced sympathoadrenal stimulation, while the protective effect of the glucocorticoid release during stress is maintained. AT1 receptor antagonism prevents the stress-induced decrease in cortical CRH1 and benzodiazepine binding and is anxiolytic. Blockade of brain angiotensin II AT1 receptors offers a novel therapeutic opportunity for the treatment of anxiety and other stress-related disorders. © 2005 Elsevier B.V. All rights reserved