Spastik kolon ve kronik gastrit, hemoroid, idrar taşı

Objective: Approximately 10-20% of the general population has irritable bowel syndrome (IBS), and IBS patients usually suffer from chronic gastritis (CG), hemorrhoids (H), and urolithiasis (U). Material and Methods: We randomly chose consecutive patients with upper abdominal discomfort. All possible causes of IBS including celiac sprue, giardiasis, lactose intolerance, and cholelithiasis were investigated. U was diagnosed either by medical history or as a result of laboratory findings. Results: IBS patients (51) and patients without IBS (70) were studied. CG was diagnosed in 78.4% (40) of IBS cases, whereas this ratio was 50.0% (35) in cases without IBS (p&lt;0.001). Similarly, H was detected in 33.3% (17) of IBS cases, but it was only detected in 15.7% (11) of cases without IBS (p&lt;0.05). Additionally, U was detected in 17.6% (9) of IBS cases and in 5.7% (4) of cases without IBS (p&lt;0.05). Conclusion: Relationships between IBS and CG, H, and U are significant. IBS is a cascade of many physiologic events that is initiated by infection, inflammation, and psychological disturbances like many stresses, and this eventually terminates with gut dysfunction. Gastric acid is probably not involved in the etiology of IBS, but psychological factors also seem to be important in CG. The significant association between CG and IBS also support this hypothesis. Therefore, we believe CG is one of terminating points of the physiologic cascade of events in IBS. Bearing these associations in mind will be helpful during prevention, treatment, and follow up of these disorders, especially in internal medicine, urology, and general surgery polyclinics and primary health centers.Amaç: Toplum genelinde spastik kolon sıklığı %10-20'dir ve bu hastalarda kronik gastrit, hemoroid ve idrar taşının da sık görüldüğü tahmin edilmektedir. Gereç ve Yöntem: Üst karın şikayetleriyle ardı sıra başvuran hastalar çalışmaya alındı. Çöliyak hastalığı, giardiaz, laktoz intoleransı ve kolelitiyazı da içerecek şekilde tüm muhtemel sebepler araştırıldı. İdrar taşı tanısı hastanın tıbbi hikayesi veya mevcut laboratuvar bulgularıyla konuldu. Bulgular: Elli bir spastik kolon hastası ve 70 spastik kolonu olmayan hasta çalışıldı. Kronik gastrit, spastik kolona sahip hastaların %78.4' ünde tespit edilirken bu oran spastik kolonu olmayan grupta %50.0 olarak tespit edildi (p<0.001). Benzer şekilde, hemoroid oranı spastik kolon grubunda %33.3 iken, spastik kolonu olmayan grupta %15.7 olarak tespit edildi (p<0.05). Ayrıca, idrar taşı sıklığı spastik kolon grubunda %17.6 iken bu oran spastik kolonu olmayan grupta %5.7 olarak tespit edildi (p<0.05). Sonuç: Sonuç olarak, spastik kolon anlamlı şekilde kronik gastrit, hemoroid ve idrar taşı ile ilişkili ve enfeksiyon, enflamasyon ve psikolojik problemler gibi birçok stres faktörünün tetiklemesiyle başlayıp genitoüriner sistem disfonksiyonuyla sonuçlanan bir olaylar şelalesidir. Kronik gastrit için de psikolojik faktörlerin önemli olduğu ve mide asiditesinin çok önemli bir sebep olmadığı düşünülmektedir ve spastik kolon ile kronik gastrit arasında tespit edilen bu anlamlı ilişki de bunu desteklemektedir. Kronik gastritin, bir fizyolojik olaylar şelalesi olan spastik kolonun son noktalarından birisi olduğunu düşünmekteyiz. Bu anlamlı birlikteliklerin akılda tutulması, bu hastalıkların önlenmesi, tedavisi ve takibinde, özellikle İç Hastalıkları, Üroloji ve Genel Cerrahi poliklinikleri ve birinci basamak sağlık kuruluşlarında klinisyenler açısından faydalı olabilir

Smoking induced atherosclerosis in cancers

WOS: 000313115600032Background: Strong associations between smoking and systemic atherosclerosis and cancers are well documented. Methods: Consecutive female and males with coronary heart disease (CHD) were studied. Results: Study included 1,620 females and 1,240 males. Prevalences of CHD were similar in both sexes (3.8% versus 4.4%, respectively, p>0.05). Mean ages of CHD cases were 61.5 versus 63.5 years in both sexes, respectively (p>0.05). Smoking and chronic obstructive pulmonary disease were significantly higher in males with CHD (54.5% versus 9.6%, p0.05 for both) probably due to small sample sizes. Whereas low density lipoprotein cholesterol and triglyceride were higher in females with CHD, significantly (132.6 versus 115.6 mg/dL, p=0.008 and 250.3 versus 150.1 mg/dL, p=0.002, respectively). Similarly, hypertension and diabetes mellitus were also higher in females, significantly (58.0% versus 30.9%, p<0.001 and 51.6% versus 38.1%, p<0.05, respectively). Conclusion: Aging alone may be the most significant disease of human being, and probably systemic atherosclerosis is the major cause of it. Smoking and excess weight may be the major causes of the systemic atherosclerotic process, and they come with similar degree of clinical severity. Although the well known mutagenic effects of smoking, its role in cancers may also be related with the systemic atherosclerotic process that immune cells can not eradicate cancer cells due to insufficient blood supply, effectively

Digital clubbing may be an indicator of systemic atherosclerosis even at microvascular level

WOS: 000314345000014Background: Presence of any relationship between digital clubbing and microvascular atherosclerosis was tried to be understood. Methods: Cases with digital clubbing and controls were studied. Results: The study included 104 cases with clubbing and 120 controls. Mean age of clubbing cases was 49.2 years, and there was a male predominance (81.7%) among them. There were significantly higher prevalences of smoking and chronic obstructive pulmonary disease (COPD) in the clubbing group (69.2 versus 41.6% and 27.8 versus 10.8%, respectively, p<0.001 for both). Although body mass index (BMI), weight, and fasting plasma glucose (FPG) were lower in the clubbing group, the differences were nonsignificant probably due to the small sample sizes. Although the negative effect of small sample sizes, prevalence of type 2 diabetes mellitus (DM) and mean value of systolic blood pressure (BP) were significanlty lower in the clubbing group (12.5 versus 21.6% and 127.6 versus 136.9 mmHg, respectively, p<0.05 for both). On the other hand, prevalence of coronary heart disease (CHD) and/or peripheric artery disease (PAD) were significantly higher in the clubbing group (7.6 versus 0.0%, p<0.01). Conclusions: There are significant relationships between digital clubbing and smoking, COPD, and CHD and/or PAD probably due to strong atherosclerotic effects of smoking with highly suspected atherosclerotic background of COPD. Whereas the BMI, weight, FPG, systolic BP, and prevalence of DM are inversely related with digital clubbing probably due to suppressor effects of smoking on appetite. So clubbing may be a significant indicator of systemic atherosclerosis even at microvascular level

Chronic obstructive pulmonary disease may be one of the terminal end points of metabolic syndrome

WOS: 000304543100007Objective: We tried to understand presence of any effect of excess weight on respiratory system by means of excessive adipose tissue functioning as an endocrine organ and causing a pulmonary inflammation. Methodology: Mild (stage 1), moderate (stage 2), and severe (stage 3 and 4) chronic obstructive pulmonary disease (COPD) patients were detected, and compared according to the metabolic parameters in between. Results: There were 145, 56, and 34 patients in the mild, moderate, and severe COPD groups, respectively. The mean age increased gradually (52.4, 56.4, and 60.0 years) from the mild towards the severe COPD groups, respectively (p<0.05 nearly in all steps). Similarly, the mean pack-years increased gradually and significantly (26.7, 34.8, and 36.8 pack-years) in the same direction (p<0.05 nearly in all steps). Parallel to them, the mean body mass index increased up to the moderate COPD cases (28.2 versus 29.6 kg/m2, p=0.039), and then decreased significantly (29.6 versus 26.8 kg/m2, p=0.006). Conclusion: The metabolic syndrome includes some reversible indicators such as overweight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired fasting glucose, impaired glucose tolerance, and white coat hypertension for the development of terminal diseases including obesity, hypertension, diabetes mellitus, peripheral artery disease, coronary heart disease, and stroke. In our opinion, COPD may be one of the terminal end points of the syndrome

Kronik hastalık anemisi ve demir eksikliği anemisi birlikteliğinin tanısında serum transferrin reseptör düzeyinin önemi

Objective: Iron deficiency anemia is the most common cause of microcytic anemia throughout the world. Ferritin levels are good indicators of iron stores; however, levels may increase irrespective of iron stores in cases of chronic disease. Therefore, it is difficult to diagnose iron deficiency anemia coexisting with anemia of chronic disease. Materials and Methods: To determine the level of transferrin receptor in subjects, 30 patients with iron deficiency anemia, 30 patients with anemia of chronic disease and 30 patients with both diseases were included in the study. Results: Mean serum transferrin receptor levels were 5.99&plusmn;2.98 mg/L in the iron deficiency anemia group, 1.90&plusmn;1.15 mg/L in the anemia of chronic disease group and 3.07&plusmn;0.90 mg/L in the combination group. Comparing groups with each other revealed significant differences (p&lt;0.05). Conclusion: It is concluded that the assessment of serum transferrin receptor levels is a useful method for the diagnosis of iron deficiency anemia in patients.Amaç: Demir eksikliği anemisi tüm dünyada en sık görülen mikrositer anemi sebebidir. Ferritin düzeyi demir depolarının iyi bir göstergesi olmasına rağmen kronik hastalık durumlarında demir depolarından bağımsız olarak yükselebilmektedir. Bu yüzden kronik hastalık anemisiyle birlikte olan demir eksikliği anemisinin tanısını koymak zordur. Gereç ve Yöntem: Transferrin reseptör düzeyinin yararını değerlendirmek amacıyla demir eksikliği anemisi, kronik hastalık anemisi ve kombine olmak üzere her gruptan 30’ar hasta çalışmaya alındı. Bulgular: Ortalama serum transferrin reseptör düzeyleri demir eksikliği anemisinde 5.99±2.98 mg/L, kronik hastalık anemisinde 1.90±1.15 mg/L ve kombine olan grupta ise 3.07±0.90 mg/L olarak bulundu. Gruplar birbirleri ile karşılaştırıldığında aralarında anlamlı farklılık saptandı (p<0.05). Sonuç: Hastalarda demir eksikliği anemisini tespit etmede, serum transferrin reseptör düzeyinin değerlendirilmesinin oldukça faydalı bir yöntem olduğu sonucuna varılmıştır

Hepatitis E virüs seropositivity in hemodialysis patients in Hatay province, Turkey

Hepatit E virusu (HEV)'nun başlıca bulaş yolu oral-fekal yol olmakla birlikte, son yıllarda virüsün zoonotik olduğu gösterilmiş, hatta parenteral ve vertikal geçişinin de mümkün olabileceği ortaya konmuştur. Yapılan çalışmalar ülkemizde HEV enfeksiyonu sıklığının artmakta olduğunu düşündürmektedir. Bu çalışmada, Hatay ilinde son dönem böbrek yetmezliği nedeniyle hemodiyaliz yapılan hastalarda anti-HEV seropozitifliğinin araştırılması amaçlanmıştır. Çalışmaya, hemodiyaliz süresi ortalama 66 ± 18 ay olan 92 hasta (54 erkek, 38 kadın; yaş aralığı: 22-71 yıl, yaş ortalaması 55 + 11 yıl) alınmış, HEV IgG antikorlarının saptanmasında ticari ELISA yöntemi (Dia.Pro Diagnostic Bioprobes, İtalya) kullanılmıştır. Çalışmamızda hastaların 19 (%20.6)'unda anti-HEV IgG pozitifliği saptanmış; 7 (%7.6) hastanın anti-HCV ve 4 (%4.3) hastanın HBsAg belirleyicileri pozitif olarak tespit edilmiştir. Anti-HEV seropozitif hastaların 2'sinde anti-HCV'nin, Tinde ise HBsAg'nin pozitif olduğu izlenmiştir. Anti-HEV IgG pozitif ve negatif hastalar arasında demografik özellikler, hemodiyaliz süresi, kan transfüzyonu, laboratuvar bulguları (trombosit sayısı, serum albumin, ALT ve AST düzeyleri) ve anti-HCV ve HBsAg pozitiflikleri arasında istatistiksel olarak anlamlı bir ilişki belirlenmemiştik (p> 0.05). Çalışmamızda saptanan anti-HEV seropozitiflik oranının (%20.6) ülkemizin batı bölgelerinde hemodiyaliz hastaları için bildirilen oranlardan (ortalama %10-16) yüksek, Güneydoğu Anadolu bölgesinden bildirilen oranlarla (ortalama %23) benzer olduğu izlenmiştir. Sonuç olarak, hemodiyaliz yapılan ya da hemodiyaliz programına alınacak olan hastaların anti-HEV yönünden taranmasının, olası bir parenteral ve/veya nozokomiyal bulaşı önlemek amacıyla gerekli tedbirlerin alınması açısından yararlı olabileceği kanısına varılmıştır.Hepatitis E virus (HEV) which is mainly transmitted through faecal-oral route, can also be transmitted via parenteral and vertical route. Recent studies suggest zoonotic nature of the virus. The last studies done in Turkey indicate increasing frequency of HEV infection. This study was conducted to determine the rate of anti-HEV seropositivity among patients with terminal stage renal failure undergoing hemodialysis. A total &ouml;f 92 patients (54 male, 38 female; age range: 22-71 years, mean age: 55 &plusmn;11 years) who had undergone hemodialysis for a mean period of 66 &plusmn; 18 months, were included to the study. HEV antibodies were analyzed using anti-HEV IgG enzyme immunoassay (ELISA, Dia.Pro Diagnostic Bioprobes, Italy). In order to study the relationship of anti-HEV positivity between hepatitis C virus and hepatitis B virus infections, anti-HCV antibody and HBsAg were also considered. Mean age, duration of hemodialysis, platelet, serum albumin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, blood transfusion history were the other evaluated parameters. Anti-HEV IgG positivity was detected in 19 (20.6%) patients, while 7 (7.6%) had anti-HCV positivity and 4 (4.3%) had HBsAg positivity. No statistically significant relation was determined between anti-HEV IgG positive and negative patients in terms of hemodialysis duration, blood transfusion, other laboratory findings and anti-HCV and HBsAg positivity (p&gt; 0.05). While the anti-HEV seropositivity rate (20.6%) determined in this study was higher than the rates determined in the same group of patients in the western part of the country (10- 16%), the ratelvas similar to the rates reported from the southeastern part (23%) of Turkey. It can be concluded that screening of patients before or during hemodialysis in terms of anti-HEV antibodies, seems to be of crucial importance in order to establish necessary precautions to prevent parenteral and/or nosocomial transmission of HEV

Multipl myelomda deri tutulumu : bir olgu sunumu

Multipl myelom (MM) kemik iliğinden köken alan ve m onoklonal immunglobulin üreten plazma hücreleri ile kara kterize hematolojik bir malinignitedir. MM’li hastalarda deri tutulumu çok nadir görülmektedir. Yetmiş üç yaşında, IgG lambda MM tanısı olan hasta deri lezyonları nedeniyle Dahiliye bölümü tarafından bölümümüze konsülte edildi. Yapılan dermatolojik muayenede üst ekstremitelerde, gövde ön ve arka yüzd e dağınık yerleşimli, çapları 2 -5 cm arasında değişen, eritemli viyolase renkte toplam 10 adet tümöral lezyon izlendi. Lezyonlardan alınan biyopsinin histopatolojik incelemesinde lambda monoklonaliteli diffüz atipik plazma hücre infiltrasyonu saptanması ne d eniyle hastanın lezyonları MM deri tutulumu olarak değe rlendirildi.Multiple myeloma (MM) is a hematological malignity that originates from the bone marrow and is characterized by plasma cells that produce monoclonal immunoglobulin. Cutaneous involvement is very rare in patients with MM. A 73 -year-old, male patient, who has a diagnosis of IgG lam bda MM, was referred to our clinic from the Department of Internal Medicine due to his skin lesions. The dermatolog ical examination revealed a total of 10 erythematous viol aceous-tumoral lesions with a diameter varying between 2 -5 cm, on upper extremities, the front and back of the body. The lesions of the patient were considered as cutaneous involvement of MM because histopathological examination of ski n biopsy is showed diffuse atypical plasma cell infiltration with lambda monoclonality

The relation of fragmented QRS with tissue Doppler derived parameters in patients with b-thalassaemia major

Purpose: The most important complication encountered in patients with b-thalassaemia major is degenerative fibrosis developing as a result of iron accumulation in myocardial tissue. Dysfunction pursues this accumulation. Recently, presence of fragmented QRS (fQRS) in ECG has been regarded as a predictor of myocardial fibrosis. We aimed in our study to investigate the frequency with which fQRS develops in patients with b-thalassaemia major and to disclose the correlation between fQRS frequency and Doppler-derived indices. Methods: The patients with b-thalassaemia major (n=66; mean age: 23±6 years) and healthy controls (n=30; mean age: 23±4 years) were included. fQRS pattern was described as presence of RSR’ manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. 2D, M-mode, conventional Doppler, tissue Doppler echocardiography parameters were assessed. Mean serum ferritin levels over past 5 years were also calculated. Results: When compared to those in control group, fQRS was more frequent in b-thalassaemia major group, indicating statistical significance (p = 0.001). While E/Em and ferritin level exhibited statistically significant increase in thalassaemia patients with fQRS (p < 0.05), the mean Em and Sm values were found to be significantly low (p < 0.05). Conclusions: fQRS was frequently observed in the patients with b-thalassaemia major, which was of statistical significance. Tissue Doppler-derived diastolic and systolic indices in thalassaemia cases with fQRS showed statistically significant impairment compared to those without fQRS. In conclusion, fQRS may represent a novel noninvasive marker for cardiac involvement in patients with b-thalassaemia major