No abstract

Gastric mucosal lesions are very common in portal hypertension and cirrhosis. The aim of this study was to assess for oxidative gastric tissue damage in cirrhosis and evaluate relations with portal hypertension and cirrhosis parameters. The study included 30 patients with cirrhosis and 30 controls. Each patient's history, physical examination, and laboratory findings were recorded, and multiple biopsies of the gastric antrum were obtained at endoscopy. A set of antral biopsies was also collected from each control subject. Each tissue specimen was analyzed for levels of glutathione peroxidase (GPX), superoxide dismutase (SOD), and catalase (CAT) activity and level of malondialdehyde (MDA). Patients' gastric GPX, SOD, and CAT levels were significantly lower, and MDA levels were higher, than in the control group. The GPX activity level in the specimens was moderately negatively correlated with portal vein diameter (P<0.05, r=-0.45) and spleen length (P<0.05, r=-0.45). In this study gastric tissue oxidative markers showed that antral oxidative factors worsen in cirrhosis. Oxidative stress may not be a clinical condition but it obviously shows gastric tissue damage and may explain many patients' gastric lesions and hemorrhage.

Pulmonary complications, mainly hepatopulmonary syndrome (HPS), are frequently observed in liver cirrhosis. In this study, the aim was to investigate the frequency of hypoxemia and impairment of pulmonary function tests (PFT) in patients with liver cirrhosis and to examine the relationships of these impairments with liver failure. A total of 39 patients with cirrhosis, 24 males and 15 females, were included in our study. The mean age of the patients was 47.5 +/- 17.2 years. Arterial blood gases, PFT, and carbon monoxide diffusion tests (DLCO) were performed in all patients. Out of 39 cirrhotic patients, 21 (53.8%) had ascites, whereas 18 (46.2%) did not. Seven patients were in the Child-Pugh A group, 21 in the Child-Pugh B group, and 11 patients were in the Child-Pugh C group. Hypoxia was found in 33.3% of the patients. Although the PaO2 and SaO2 values of patients with ascites were lower compared to those without ascites (P < 0.05), no statistically significant difference was determined in the comparison of hypoxia between the groups (P > 0.05). Among the PFT parameters, FEV1/FVC and FEF25-75% values were found to be lower in patients with ascites than those without (P < 0.05). No differences were established between these two groups of patients in terms of DLCO (P > 0.05). While no differences were found in comparison of the DLCO values in between the groups (P > 0.05), there was a statistically significant difference in the ratio of DLCO to the alveolar ventilation (DLCO/VA) in between the groups (P < 0.05). On the other hand, a negative correlation was found between the DLCO/VA and Child points when the relationship between the Child-Pugh score and PFT parameters were investigated (r = -0.371, P < 0.05). Consequently, a relationship was established between the severity of liver failure and diffusion tests showing pulmonary complications invasively. We believe diffusions tests should be performed in addition to the PFT in order to determine pulmonary involvements particularly in patients who are candidates for liver transplantation.

The study included 114 women (70.8%) and 47 men (29.2%). The mean age of the patients was 36.82 ± 10.41 years, and the mean BMI was 46.05 ± 3.76 kg/m. H. pylori infection was detected in 103 (64%), chronic gastritis in 156, chronic active gastritis in 47, intestinal metaplasia in eight, and atrophy in seven patients. The rate of H. pylori-associated chronic gastritis was 64%, that of chronic active gastritis was 24.2%, that of lymphoid aggregation was 62.2%, and that of intestinal metaplasia and atrophy was 3.1%. There was a significant relationship between H. pylori infection and chronic gastritis, chronic active gastritis, and lymphoid aggregation; however, no significant relationship was found between intestinal metaplasia and atrophy. CONCLUSıON: Clinicians should be aware of the histopathological findings requiring clinical follow-up for LSG-treated patients. Given the complications of H. pylori infection such as lymphoma and malignancy, periodic follow-up of patients and eradication therapy may be a suitable approach for treating intestinal metaplasia and atrophic changes.

Amaç: Bu araştırmanın amacı, primer hipotiroidizmi olan hastalarda depresif semptomların sıklığını araştırmak, bu semptomların levotiroksin (LT4) tedavisi sonrası iyileşme düzeyini belirlemek ve öngörücü semptomların varlığını değerlendirmektir.Yöntemler: 140 primer hipotiroidizmi olan kadın hasta Beck Depresyon Envanteri (BDÖ) ile değerlendirildi. Hepsi sadece LT4 ile tedavi edildi. Tiroid stimüle edici hormon (TSH) değeri tedaviden sonra test edildi ve daha önce depresif belirtiler gösteren hastalar BDÖ ile tekrar değerlendirildi.Bulgular: Çalışmamızda 72 (%51.4) hastada (BDÖ=22.8±1.1, TSH=19.1±3.7 iU/ml, yaş (yıl)=44.0±2.0) depresif belirti olduğu ve 68 hastada (%48.6) ise olmadığı gösterildi. (BDÖ=8.7±0.6, TSH=12.0±1.2 iU/ml, yaş (yıl)=45.0± 2.2). Primer hipotiroidizmin tedavisinden sonra, çalışmanın ilk bölümünde depresif belirtiler gösteren 72 hastada (TSH sonrası 1.54 iU/ml ±0.31) BDÖ tekrar uygulandı ve 54 hastanın (%75) depresif belirtilerinin ortadan kalktığı görüldü (BDÖ=9.0±1.0, TSH=1.59±0.31 iU/ml, yaş (yıl)=45.0±2.0). Hastaların 18'inde (%25) depresif semptomların devam ettiği görüldü (BDÖ=23.0±2.0, TSH=1.28±0.31 iU/ml, yaş (yıl)=42.0±2.0). Uyku bozukluğu, madde 16, tedaviden sonra belirgin kalıcılığı olan tek faktördür (p > 0.045).Sonuçlar: Hipotiroidizmli hastaların %51.4'ü depresif belirtiler gösterdi. Hipotiroidizm tedavisi tüm olgularda TSH değerlerini normal seviyesine getirmek ve %75'inde depresif belirtileri tersine çevirmek için yeterliydi. Kalan %25'lik grupta uyku bozukluğunun devam etmesi, öngörücü, yanıtsız bir semptom olarak düşünülebilir ve tanıyı tekrar değerlendirmek ve başka bir tedavinin eklenmesini göz önünde bulundurmak gerektiğine işaret eder. Anahtar kelimeler: Major depresif bozukluk, hipotiroidizm, levotiroksin, uyku bozuklukları Doi:Abstract Aim: The aim of this study was to investigate the frequency of depressive symptoms in patients with primary hypothyroidism, to determine the degree of recovery of these symptoms after levothyroxine (LT4) treatment, and to assess the presence of predictive symptoms.Methods: 140 women with primary hypothyroidism were evaluated with the Beck Depression Inventory (BDI). All were treated with LT4 alone. Thyroid stimulating hormone (TSH) value was tested after treatment and patients with previous depressive symptoms were reevaluated with BDI.Results: In our study, it was shown that 72 (51.4%) patients had depressive symptoms and 68 patients (48.6%) did not have depressive symptoms (BDI=22.8±1.1, TSH=19.1±3.7 iU/ml, (BDI=8.7±0.6, TSH=12.0±1.2 iU/ml, age (year)=45.0±2.2). After the treatment of primary hypothyroidism, BDI was reapplied in 72 patients with depressive symptoms (1.54 iU/ml±0.31 after TSH) in the first part of the study and depressive symptoms of 54 patients (75%) were found to be absent (BDI=9.0±1.0, TSH=1.59±0.31 iU/ml, age (years)=45.0±2.0). Depressive symptoms persisted in 18 (25%) of the patients (BDI=23.0±2.0, TSH=1.28±0.31 iU/ml, age (year)=42.0±2.0). Sleep disturbance, item 16, is the only persistent persistence after treat...

Objective: We evaluated the clinical features and the effects of various treatment modalities on the clinical course in patients diagnosed with idiopathic thrombocytopenic purpura (ITP). Materials and Methods: Retrospective investigation of the medical records of 168 patients at our center between 1994 and 2005 was done. Results: Of the 168 patients, 115 (68.4%) were women and 53 (31.6%) men. At initial diagnosis, the median age of the patients was 33 years (range: 15–91) and 139 (82.7%) had signs of bleeding. Follow-up was complete in 130 patients and the median follow-up was 27 months (range: 3–132). Initial treatment with either standard or high-dose steroid as first-line therapy was begun in 123 (73.2%) of the 168 patients. Complete remission (CR) was achieved in 56% of the patients. Sixty-one (61) patients who were followed up regularly received second-line therapies. CR was achieved in 45.8% of the patients who received steroids as second-line therapy. Within a median follow-up of 7 months, 27.2% of these patients relapsed. Splenectomy was performed in 26 patients and CR was obtained in 72% of the 25 patients regularly followed up. CR obtained by splenectomy was significantly higher than that obtained by steroids (p < 0.001). The 10-year disease-free survivals in patients who used steroids and who underwent splenectomy were 15 and 61.6%, respectively. Conclusion: Steroid therapy is effective both in the initial and relapse periods. Splenectomy is the treatment of choice for those ITP patients refractory to steroid therapy and younger than 40 years of age.

Objective:We aimed to demonstrate the relationship between the endoscopically increased mucosal damage and the frequency of dyspeptic symptoms in patients with diabetes. Material and Methods:The 42 diabetic patients with dyspeptic complain and 40 healthy dyspeptic people were involved in this study and evaluated with video endoscopes.Results: Diabetic patients when compared with the control group according to the endoscopic evaluation and Glasgow Dyspepsia Symptom Scoring System no significant difference had been detected. The symptoms of the diabetic group and the control group were familiar and there was no significant difference between the frequencies of the symptoms in both groups. In dyspeptic diabetic patients a weak correlation between BMI and endoscopically detected hiatal hernia was reported. However there was no relation between BMI and the other gastrointestinal symptoms. Also there was no difference between the patients with neuropathy and without neuropathy in terms of endoscopic findings and gastrointestinal symptoms. Conclusion:Endoscopic findings of diabetic patient and non-diabetic control group were compared statistically. Although gastric ulcus was significantly higher in diabetic group, there was no significant difference between two groups in terms of other endoscopic findings. Hovewer, gastric ulcus frequency in diabetic group is higher, there were no significant difference in terms of gastrointestinal symptoms, diabetic complications and glisemic control in patients with other endoscopic lesions when compared with the patients with gastric ulcus. Hiatal hernia frequency in diabetic patients was higher due to control group. In shed light on our findings, diabetic patients must be evaluated for the esophageal reflux symptoms.

Restless leg syndrome (RLS), which is a chronic neurosensory-motor disorder, is a disease which is usually accompanied by disturbing or unpleasant sensations, characterised by an irresistible impulse for moving the legs. This sensation which may be as a severe pain may temporarily relieve with movements.Prevalence of RLS varies between 4% and 10% in the general population. 1 RLS, which is characterised by delay in starting sleep, difficulty to maintain sleep, decreased total sleeping time and impairment in slow-wave sleep, leads to an impairment in quality of life. 2 Depression, anxiety and pain disorders are common co-morbid conditions which accompany RLS. 3 Diabetes, cardiovascular disease and stroke risk may also increase in RLS patients. 4 While early-onset RLS (before 45 years) is usually idiopathic, 5 secondary RLS (after 45 years) mainly occurs due to iron deficiency, pregnancy and end stage renal disease (ESRD). Although patho-physiology of RLS is not clear yet, it is considered to be associated with cerebral iron metabolism dysfunction, which leads to abnormal dopaminergic outcomes, 6,7 together with an underlying genetic predisposition. 1,6 Obesity is an important community health problem which is responsible for an important part of sleep-related complaints. 8 It is directly related with sleep disorders like obstructive sleep apnea syndrome and insomnia. 9 The association between RLS and obesity has been investigated in many studies as RLS is also a sleep disorder. RLS patients were reported to have higher BMI values compared to the patients without RLS. 10 RLS prevalence was reported to be higher in obese individuals compared to the non-obese. 11 Similar changes in dopamine metabolism in RLS and obesity have shown a potential relationship between them. 12,13 The factor like iron deficiency having an important role in etio-pathogenesis of RLS, 6 the relationship between obesity and iron deficiency, 14 increase the importance of obesity as a risk factor for RLS.Given the close relationship between obesity and RLS, the aim of this study was to investigate whether RLS symptoms improved and treatment requirement decreased through weight loss on postoperative followups of the patients who underwent LSG due to obesity and who were started medical therapy due to RLS.