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Biomedical subjects

S Sezai

Publications and source records attributed to S Sezai.

At least 19 recordsLinked to original sources
PubMed2000

Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding.

BACKGROUND: Three hundred and forty-five patients who underwent urgent colonoscopy for acute hematochezia during the past 20 years (from 1976 to 1995) were retrospectively analyzed. METHODS: Urgent colonoscopy was defined as endoscopy performed within 24 h after a bleeding episode. Preparation was initially minimal with a water or glycerine enema. Recently, however, polyethylene glycol is used. RESULTS: The overall diagnostic accuracy for bleeding site detection was 89.1% (307 cases). Successful insertion was made to the ileocecal region in 193 cases (55.9%). The disease most frequently discoverd by urgent colonoscopy was transient ischemic colitis (62 cases). Negative urgent colonoscopy specimens (18 cases) were later diagnosed by other methods as being small intestinal bleeding foci. In 10 cases, initial colonoscopy failed to detect the bleeding foci. Endoscopic hemostasis was performed in 48 cases. Permanent hemostasis succeeded in 32 cases (66.7%). Complications of urgent colonoscopy were fever after the examination (22 cases) and hypotension during endoscopy (7 cases). CONCLUSION: Urgent colonoscopy is considered to be a safe and useful examination for acute lower gastrointestinal bleeding and hemostasis.

Acute Disease↗
PubMed1998

Clinical features of paradiverticulitis.

Colonic diverticula have been generally accepted as a source of massive hemorrhaging. Little is known, however, about fecal occult blood loss from colonic diverticula and diverticulosis. We retrospectively investigated the possibility of minor bleeding in 737 diverticula cases diagnosed from April 1989 to May 1994. Thirty-seven cases (5%) of diverticula are explained as the sources of positive occult blood testing ascertained clearly by colonoscopy. These divide into three types: (1) from intradiverticular bleeding (intradiverticulitis), (2) from peridiverticular bleeding (peridiverticulitis), and (3) from interdiverticular colonic mucosal erosion (interdiverticulitis). These findings account for the occult blood loss that we call paradiverticulitis. The two-year prospective study found 67 cases (11.3%) of paradiverticulitis in 595 diverticula cases. We concluded that paradiverticulitis is one of the causes of positive occult blood tests.

Colonoscopy↗
PubMed1998

Effects on gastric circulation of treatment for portal hypertension in cirrhosis.

We evaluated the gastric circulatory effects of the type of treatment administered for portal hypertension. Of 14 patients with cirrhosis, seven received a transjugular intrahepatic portosystemic shunt (TIPS; group T) and seven received percutaneous transhepatic portographic embolization (PTPE; group P). Patients were evaluated over the course of one year. After treatment, portal venous pressure was significantly reduced from 39 +/- 6 cm H2O to 32 +/- 5 (P < 0.001) in group T and was significantly elevated from 29 +/- 10 to 33 +/- 8 (P < 0.05) in group P. The portal flow velocity (Vmean) was significantly higher in group T vs group P (P < 0.0001). The congestion index was significantly lower in group T than in group P (P < 0.0001). The gastric mucosal blood flow was increased in group T but was unchanged in group P. Esophageal varices showed some improvement in both groups, but the portal hypertensive gastropathy was improved only in group T. These findings help to explain the differing effects on the gastric circulation related to the type of treatment used for portal hypertension.

Embolization, Therapeutic↗
PubMed1998

Regulation of hepatic thrombopoietin production by portal hemodynamics in liver cirrhosis.

OBJECTIVE: This study was designed to clarify how thrombopoietin (TPO) functions in and, to some extent, causes thrombocytopenia complicating liver cirrhosis and portal hypertension. METHODS: Our study population consisted of 19 cirrhotic and six noncirrhotic patients who underwent percutaneous transhepatic portography (PTP) and hepatic venography. RESULTS: The platelet counts of the cirrhotic patients were significantly lower than those of the noncirrhotic patients (8.7 +/- 4.1 vs 17.4 +/- 7 x 10(4)/microl; p < 0.01). The flow direction in the splenic vein was confirmed by PTP. Ten hepatofugal and nine hepatopetal flow directions in the splenic vein were noted among the cirrhotics. The hepatofugal group showed lower portal venous pressure (20 +/- 10 vs 32 +/- 4 cm H2O; p < 0.01) than the hepatopetal group and had a higher incidence of hepatic encephalopathy (six of 10 vs zero of nine; p < 0.01). The hepatic vein-portal difference in TPO did not differ substantially between the cirrhotics and noncirrhotics (0.12 +/- 0.04 vs 0.24 +/- 0.07 fmol/ml). Comparisons of this value among the three groups showed the TPO difference to be lowest in the hepatofugal group (hepatofugal: 0.04 +/- 0.03, hepatopetal: 0.21 +/- 0.07, noncirrhotic: 0.24 +/- 0.07; p < 0.05). CONCLUSIONS: Our findings suggest that TPO production in the cirrhotic liver is regulated by the portal blood supply to the liver. Thus, portal hemodynamics may play a critical role in the development of thrombocytopenia.

Aged↗
PubMed1997

Acinar-islet cell carcinoma presenting as insulinoma.

A case of acinar-islet cell carcinoma presenting as insulinoma is reported. The patient was a 28-year-old man who presented with two convulsive episodes. Fajans' index [immunoreactive insulin (IRI; microU/ml/ glucose mg/dl)] and Turner's [IRI (microU/ml) x 100/glucose (mg/dl) - 30] index were high (2.8 and 308, respectively), as were serum proinsulin levels (550 pg/ml). Abdominal computed tomography and angiography revealed a highly vascular tumor in the pancreatic tail and several similar tumors in the liver. Histologic features of a biopsy specimen from a hepatic tumor were those of a malignant pancreatic endocrine tumor. Insulin secretion by the liver metastases was confirmed by venous sampling after arterial stimulation with calcium. These findings led us to diagnose malignant insulinoma with liver metastases. Serum levels of alpha-fetoprotein and trypsin were markedly elevated, to 2234 ng/ml (normal < 10) and 22,000 ng/ml (normal < 460) respectively, and these levels continued to rise with further growth of the liver metastases. Immunohistochemically, the metastatic liver tumor specimen was positive for alpha-fetoprotein, alpha 1-antichymotrypsin, chromogranin A, and neuron-specific enolase. These findings of amphicrine features in the tumor were indicative of acinar-islet cell carcinoma that produced alpha-fetoprotein and trypsin in addition to insulin.

Adenoma, Islet Cell↗
PubMed1997

[A long-term histological prognosis after IFN therapy for chronic hepatitis C].

In 72 chronic hepatitis C patients treated with IFN, liver biopsies were performed before and after IFN treatment, and histological changes were examined. In complete responders, the grading score improved significantly since 6-mo after IFN treatment, and the staging score improved significantly since 12-mo after IFN treatment. In long-term responders underwent a following liver biopsy 4-5 yr after IFN treatments; 5 had normal liver histology. In partial responders, both the grading and staging score did not improve significantly. But, in the cases who had sustained normalization of ALT levels after IFN treatment, both the grading and staging score improved after treatment. In non-responders, both the grading and staging score did not improve significantly.

Biopsy↗
PubMed1996

Reduced thyroidal uptake of inorganic iodine in liver cirrhosis.

Thyroid function was investigated in patients with liver cirrhosis. 123I uptake after four hours was significantly reduced in the liver cirrhosis group (n = 19) compared with the control group (n = 16) (2.6 +/- 0.3% vs. 5.0 +/- 0.6%, mean +/- SE, p < 0.01). There was no significant difference in the blood inorganic iodine level between the two groups, and the blood 123I count after ingestion of 123I capsules was not significantly different between the two groups. The area of the thyroid was slightly smaller in the cirrhosis group. A thyroid stimulating hormone (TSH) loading test showed no significant difference in the TSH value at any time point. The serum albumin level and prothrombin time were significantly associated with the 4-hour thyroidal 123I uptake (p < 0.01, p < 0.05, respectively). We show that the thyroidal inorganic iodine uptake was reduced in patients with liver cirrhosis and this reduction correlates with the severity of liver cirrhosis. Possible mechanisms include abnormal thyroid iodine transport capacity or reduced turnover of thyroid hormones resulting in a reduction in iodine uptake in liver cirrhosis.

Bilirubin↗
PubMed1995

[Usefulness of every-other day administration of proton pump inhibitors from the standpoint of continuous 48-hour pH measurements-- Comparison of cimetidine, omeprazole, and lansoprazole].

We compared the usefulness of proton pump inhibitors (PPIs) every other day, with H2-blocker, in terms of inhibitory effect on gastric acid secretion. The dosages were as follows; cimetidine (CIM), 800mg and 400mg every day; omeprazole (OPZ) 20mg, and lansoprazole (LPZ), 30mg every other day. We continuously measured intragastric pH and calculated the time that pH was maintained at pH4 or more (pH4 holding time). The pH4 holding time as a part of total measurement time was significantly longer in the PPI every other day groups than in the H2-blocker groups, but there were no significant differences between the groups during the night. In PPI every other day groups, pH4 holding time of daytime period was suggested to be longer than on H2-blocker groups. In conclusion, their efficacy was greater than in the CIM group, and they appear to have a broad range of applications to the treatment of peptic ulcer.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

[Detection of Helicobacter pylori by culture and the 13C-urea breath test using an automated breath 13C analyzer].

Up to now, the diagnosis of H. pylori infection has been made by the breath test using 13C-urea. In this study, 13C-urea breath samples were tested in 34 patients (peptic ulcer scar 17, chronic gastritis 17 cases) with an automated breath 13C analyzer (ABCA. Europa Scientific, Crewe, UK) and compared with the results of endoscopical diagnosis for H. pylori infection. Endoscopic and 13C-urea breath test (13C-UBT) were performed before eradicative medication. We described a modified protocol for the growth grade of H. pylori colonies in microbiology (H. pylori score), and for the delta 13C area under curve (AUC; permil*hr) obtained from each sample of expired breath. There was a significant correlation between delta 13C-AUC and the delta 13C level of each sample, but the correlation coefficient obtained at 10min (R2 = 0.582) was lower than that obtained at the other four time points (20min; 0.891, 30min; 0.949, 40min; 0.946, 50min; 0.946, 60min; 0.820). The delta 13C-AUC well correlated with H. pylori score (p < 0.01), none of 26 H. pylori positive patients detected by culture was 13C-UBT negative (delta 13C-AUC < 8.2 permil*hr in mean + 2SD of H. pylori negative group). In conclusion, 13C-UBT using ABCA has high sensitivity and specificity, and it provides a non-invasive method for the detection of H. pylori urease activity.

Breath Tests↗
PubMed1993

Hepatic arterial and portal venous oxygen content and extraction in liver cirrhosis.

We examined the oxygen content in the hepatic arterial, hepatic venous and portal venous blood to evaluate the oxygen supply to the liver and hepatic oxygen extraction in cirrhosis. The arterial-portal venous difference of the oxygen content was within the normal range in cirrhosis patients, although the oxygen content of the hepatic artery and portal vein was lower than in the control patients. The hepatic venous oxygen content was normal in the cirrhosis patients. The oxygen tension and saturation were always higher in the splenic vein than in the other branches of the portal system. Oxygen was supplied chiefly by the hepatic artery, and arterial oxygen extraction was normal in cirrhosis. In addition, there was no change in arterial extraction during oxygen inhalation by cirrhosis patients. Portal venous oxygen extraction was decreased in cirrhosis and was increased by oxygen inhalation. These findings indicate the autoregulation of hepatic oxygen through a mutual relationship between the hepatic arterial and the portovenous oxygen supply.

Female↗
PubMed1992

Effect of hepatic collateral hemodynamics on gastric mucosal blood flow in patients with liver cirrhosis.

The dependence of the gastric mucosal change in liver cirrhosis on the extrahepatic collaterals is still unknown. Therefore we studied the influence of these collateral hemodynamics on gastric mucosal blood flow and gastric mucosal lesions. The subjects were 23 cirrhotic patients and were divided into two groups by the findings of percutaneous transhepatic portography. The first group consisted of 14 cases whose extrahepatic collaterals were via esophageal varices (group I). The second group included 9 cases having collaterals other than esophageal varices (group II). Multiple red spots were observed in 13 of 14 cases in group I, and two of nine cases in group II. Gastric mucosal blood flow was 2.0 +/- 0.9 volts (mean +/- SD) in group I, 4.0 +/- 1.2 in group II. A statistically significant difference was observed between groups I and II. Gastric mucosal blood flow was not significantly correlated with portal venous pressure in group I. It is concluded that, in liver cirrhosis, gastric mucosal blood flow is changeable according to the types of the extrahepatic collaterals.

Aged↗
PubMed1991

Osteodystrophy in liver cirrhosis: detection and treatment evaluation using 99Tcm methylene diphosphonate bone scintigraphy.

To investigate osteodystrophy in liver cirrhosis, 99Tcm MDP (methylene diphosphonate) bone scintigraphy was performed on 36 patients with liver cirrhosis. Abnormal lesions were detected in 17 out of 36 scans (47.2%). On the other hand, areas of increased uptake were uncommon in patients with chronic active hepatitis (1/11 cases). Plasma vitamin D3 fractions [25(OH)D3, 24.25(OH)2D3 and 1.25(OH)2D3] were decreased. Statistically significant depletion of 1.25(OH)2D3 was observed in cases with positive bone scintigraphy. 1 alpha(OH)D3 (1-2 micrograms/day) was administered for 6 months to nine patients having abnormal bone scans. Six of them showed improvement without any apparent side-effects. We conclude that hepatic cirrhotic osteodystrophy can be diagnosed positively by 99Tcm MDP bone scintigraphy and can be treated accordingly.

Adult↗
PubMed1990

[The study of endotoxin levels in portal venous system in liver cirrhosis].

In the patients with liver cirrhosis, endotoxin levels were measured in portal venous system by the toxicolor method and the mechanism of endotoxemia in the peripheral vein was studied. On endotoxin levels in portal venous system, the superior mesenteric vein had the highest level. Endotoxemia was observed most frequently in the superior mesenteric vein (78%), and 50% in the truncal portal vein and 55% in the peripheral vein. The hepatic "endotoxin extraction ratio" which is considered to reflect the Kupffer cell function of clearing endotoxin and the severity of cirrhosis were not related each other. On the other hand, in view of the extrahepatic portal shunt, systemic endotoxemia appeared more frequently in the patients with the other collaterals than the esophageal varices. Therefore, it was concluded that systemic endotoxemia in liver cirrhosis was related with the type of extrahepatic portal collaterals.

Aged↗