EN was at least effective as ranitidine plus EN as SUP.

The treatment of chronic anal fissure must be individualized depending on the different clinical profiles of patients. Botulinum toxin injection has a higher recurrence rate than LIS, and LIS provides rapid and permanent recovery. However, LIS carries a higher risk of anal incontinence in patients.

Methemoglobinemia and hemolysis are rare findings following phosphine poisoning. In this paper, a case of aluminum phosphide (AlP) poisoning complicated by methemoglobinemia and hemolysis with a successful treatment is reported. A 28-year-old male patient presented following intentional ingestion of an AlP tablet. In this case, hematuria, hemolysis and methemoglobinemia were significant events. A methemoglobin level of 46% was detected by CO-oximetry. The patient was treated with ascorbic acid and methylene blue and he also received supportive care. Two weeks after admission, the patient was discharged from the hospital. Hemolysis and methemoglobinemia may complicate the course of phosphine poisoning.

No abstract

BACKGROUND A dramatic rise in the rate of clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD) has been reported in recent years. METHODS In this observational case control study, 65 patients were included and were divided into two groups of IBD + CDI as case group and IBD without CDI as control group. RESULTS 35 patients who had positive test for clostridium difficile were assigned to the case group. The control group consisted of 30 patients with negative test for clostridium difficile. Pancolitis was seen in the cases more statistically significant than the controls and proctitis was seen more among the controls than the cases (p = 0.001). The cases were on immunosuppressive (p = 0.001) and antibiotic (p = 0.02) therapy more than the controls. Colonoscopic findings revealed more severe and extensive inflammation among the cases versus milder inflammation among the controls, but these differences were not statistically significant (p = 0.2). Colectomy was seen in 10% of controls and none of the cases and this difference was statistically significant (p value = 0.05). More fecal calprotectin were seen among the cases than the controls and this difference was statistically significant (p < 0.05) CONCLUSION This study showed more clostridium difficile infection among the patients on antibiotic or immunosuppressive therapy. Pathological investigation revealed more severe and extensive inflammation among the cases than the controls. Cases had clinically more severe signs and symptoms with higher mayo scores than the controls. ESR (Erythrocyte sedimentation rate) and fecal calprotectin were higher in patients with positive clostridium difficile infection and serum albumin was lower in such patients.

Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has evolved as the surgical procedure of choice for ulcerative colitis (UC). The aim of our study was to evaluate the quality of life (QOL) of UC patients who underwent this procedure over 5 years ago. Thirty-nine UC patients who underwent restorative proctocolectomy with IPAA were interviewed by the validated inflammatory bowel disease questionnaire (IBDQ). Each patient was assigned a score, ranging from 32 to 224, in which the highest score indicates the best QOL. QOL for postoperative patients was good in 15 (38.5 %), regular in 23 (59 %), and bad in 1 (2.6 %) patient. QOL was not significantly influenced by age or gender of the patient. The emotional aspect received the highest score in the IBDQ and for each question that was analyzed separately; most of the patients were pleased and thankful with their lives and this question received the highest score. Long-term QOL was good in UC patients who underwent IPAA. This operation should be considered as the first choice since the patients were stable after long-term follow up.

Amaç: Gastrointestinal bozukluklar, düflük doz enterik-kapl› formu kullan›lsa bile aspirin tedavisinin hayati yan etkilerindendir. Bu çal›flman›n amac›, gastrointestinal kanamal› hastalarda düflük doz enterik-kapl› aspirine ba¤l› üst ve alt endoskopik bulgula Background/aims: Gastrointestinal disorders are important side effects of aspirin therapy, even if the low-dose enteric-coated form is administered. The aim of the current study was to present the upper and lower endoscopic features of patients with gastrointestinal hemorrhage using low-dose enteric-coated aspirin. Materials and Methods: This prospective study was conducted among 633 consecutive patients with gastrointestinal hemorrhage who admitted to our tertiary referral hospital for endoscopy assessment. Patients were divided into two groups as low-dose aspirin users (n=168) and non-aspirin users (n=495). Aspirin users included tho-

We reviewed the comments in the letter to editor and would like to thank the author for his interesting questions. The author's concern about the frequency of methemoglobinemia in acute aluminum phosphide (AlP) poisoning prompted us to search the Medline database using the terms "methemoglobinemia" and "aluminum phosphide and "poisoning" and found 4 papers in addition to our recent paper. [1][2][3][4] Of these publications, one was a study using rats and not in human, [1] 2 others were case reports, [2,3] and one was series of 48 human cases. [4] In the last paper, [4] in written by authors in our institution, most patients did not have an elevated MetHb, though there was an association between metHb concentration and death.