Investigation the relaxant effects of proton pump ınhibitors and their relaxation mechanism on sheep sphincter of Oddi

Background

Using a relaxant agent before an endoscopic retrograde cholangiopancreatography (ERCP) might reduce complications.

Study Aims

We aimed to investigate the relaxant effects of proton pump inhibitors (PPIs) on sheep sphincter of Oddi (SO) and the mechanisms that might take part in this relaxant effect.

Patients and Methods

The sheep SO was mounted in an organ bath filled with Krebs-Ringer bicarbonate solution under 1.5 g tension and the relaxant effects of PPIs were evaluated in the tissues precontracted by carbachol (10^-6 mol/l). The relaxant responses to the PPIs were tested in the presence of various blockers to enlighten the underlying mechanism by the PPIs.

Results

The PPIs exerted relaxant responses in a concentration-dependent manner in the sheep SO (P < 0.05). Esomeprazole produced the strongest relaxation. The administration of atropine, indomethacin, L-NAME, methylene blue, clotrimazole, glibenclamide, and 4-aminopyridine into the organ baths did not change the relaxations induced by PPIs in vitro (P> 0.05). On the other hand, Ca⁺²-activated potassium channel blocker tetraethylammonium (TEA) reduced the relaxation responses created by PPIs (P < 0.05).

Conclusions

The present study suggests that PPIs create relaxation on SO partially via Ca⁺²-activated potassium channels. PPIs, especially esomeprazole, may be beneficial during the ERCP procedure. Further clinical studies are needed to confirm our results.

Effect of Vitamin D Treatment on Serum Sclerostin Level

Objective Sclerostin is an osteocyte-secreted endogenous inhibitor of Wnt signaling. Several systemic and local factors have been suggested as possible regulators of sclerostin expression by osteocytes. In this study, we examined the effect of vitamin D treatment on sclerostin levels. Subject and Methods 44 patients with diagnosis of vitamin D deficiency (25(OH)D≤20 ng/ml) were involved in the study. Patients had monthly intramuscular injection of 300.000 IU cholecalciferol for 3 consecutive months. Sclerostin, 25(OH)D, parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) levels were measured during the diagnosis and after the replacement of vitamin D. Results 8 male and 36 female patients were enrolled in the study. Minimum age, maximum age and average age were 21, 55 and 32.02±9.26 years, respectively. A statistically significant difference was observed between the pre-treatment and post-treatment values in 25(OH)D levels (p:0.001, 10.27±4.62 ng/ml and 51.40±14.62 ng/ml, respectively), PTH levels (p:0.001, 50.32±19.05 pg/ml and 33.97±13.12 pg/ml, respectively) and sclerostin levels (p:0.002, 858.98±351.63 pg/ml and 689.52±197.92 pg/ml, respectively). No statistically significant difference, however, was found between the pre-treatment and post-treatment calcium, phosphorus and ALP levels. Correlation analysis made on pre-treatment and post-treatment sclerostin levels and 25(OH)D, PTH, calcium, phosphorus and ALP levels revealed no statistically significant correlation. Conclusion Our findings show that the sclerostin level of patients with vitamin D deficiency decreases considerably through treatment.

Effect of sildenafil citrate on secondary healing in full thickness skin defects in experiment

OBJECTIVES

An acceleration of the wound healing process expedites chronic wound patient's return to normal social environments significantly. Sildenafil, a cyclic guanosine monophosphate (cGMP)-dependent phosphodiesterase- 5 inhibitor has been shown to be a potent stimulator of angiogenesis through upregulation of cGMP. In our study, sildenafil was administered orally as a cost-effective supplement in the treatment of full thickness defects and chronic wounds in that manner with low incidence of side effects and morbidity.

MATERIALS AND METHODS

Randomly selected 72 Wistar-Albino rats were divided into the two groups, 36 rats in each group. Control group (n =36) was divided further into a secondary healing group consisting of 9 rats and a pathology group consisting of 27 rats (pathology group 1: 9 rats, 4th and 7th day of wound healing, pathology group 2: 9 rats, 10th and 14th day of wound healing, pathology group 3: 9 rats, 21st and 28th day of wound healing. Experimental group consisted of 36 rats which received sildenafil citrate (Viagra® Pfizer, Germany) for secondary wound healing to proceed.

RESULTS

The average wound healing period in the control group was 17.89 days and in the sildenafil citrate administered group 14.56 days. The difference of the epithelialisation on full thickness defects were more prominent on days 5 and 11 postoperatively. In the sildenafil citrate applied group, on the 7th day, the defect was 25% smaller and on the 13th day, the defect contracted by 38%.

CONCLUSION

In conclusion, we believe that sildenafil citrate administered orally is a cost- effective supplement in the treatment of full thickness defects and chronic wounds in that manner with low incidence of side effects and morbidity (Tab. 4, Fig. 7, Ref. 34).

Steatohepatitis and liver cirrhosis in Chanarin-Dorfman syndrome with a new ABDH5 mutation

Chanarin-Dorfman syndrome (CDS) is an autosomal recessive neutral lipid storage disease. It is very rare and characterized by ichtiosis, intracellular fat droplets in leucocytes (Jordan anomaly) and involvement of multiple tissues (skeletal muscle, central nervous system, bone marrow, eye and ear) mainly the liver. Our patients were diagnosed as CDS because they had ichtiosis, Jordon anomaly of leucocytes in peripheral blood smear, liver involvement and presence of homozygous 88 insertion C frame shift mutation on exon 4 of ABHD5/CGI-58 gene in genetic analysis. Our cases were two sisters. One of them developed severe steatohepatitis on age 19 and the other one was diagnosed as decompensated cirrhosis when she was 26 years old. We report here a new mutation in comparative gene identification-58 (CGI-58) gene causing syndactyly and steatohepatitis induced early cirrhosis.

The view of patients with asthma or chronic obstructive pulmonary disease (COPD) on complementary and alternative medicine

BACKGROUND

The popularity of complementary and alternative medicine (CAM), particularly for chronic diseases such as asthma, is growing rapidly, but little is known about the characteristics of CAM use by patients with asthma and chronic obstructive pulmonary diseases (COPD). The aim of the present study is to compare the knowledge and preferences of patients with asthma or COPD about CAM, to evaluate the extent, characteristics and possible predictors of CAM use.

METHODS

A face-to-face interview questionnaire was administered to the patients who attended the Allergic Diseases and Chest Diseases clinics between May 2005-January 2006, and 364 patients answered the questionnaire.

RESULTS

43.1 % (n = 90) of the 209 asthmatic patients, and 43.2 % (n = 67) of the 155 COPD patients had used some type of CAM previously. The asthmatic patients who have been admitted to the Emergency Room(ER) more frequently tend to use CAM methods (p = 0.03), whereas duration of doctor diagnosis, hospitalizations, admissions to ER and to be educated for diseases have a higher impact on CAM use in COPD patients (p = 0.00, p = 0.00, p = 0.00 and p = 0.04, respectively). The most commonly used forms of CAM were herbal medicines (57.8 % vs. 70.1 %) and quail egg (46.7 % vs. 37.3 %) in patients with asthma and COPD, respectively. The reported frequency of the subjective sense of improvement was higher in asthmatic patients than COPD patients but this difference was insignificant (50.0 % vs.39.4 %; p = 0.24).

CONCLUSION

Most of the patients with asthma or COPD prefer alternative medicine. CAM use by patients with COPD should be asked about by their doctors, strongly advised about continuing their medicines and about side effects of CAM.

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

STUDY DESIGN

A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats.

SETTING

Diyarbakir, Turkey.

METHODS

In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats).

RESULTS

Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P=0.04), middle scar (P=0.001), deep scar (P=0.001) and dural adhesion (P=0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P=0.01).

CONCLUSION

In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.