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Acute pancreatitis: an obscure complication of organophosphate intoxication
(Sage Publications Ltd, 2003) Harputluoglu, MMM; Kantarceken, B; Karincaoglu, M; Aladag, M; Yildiz, R; Ates, M; Yildirim, B
Acute pancreatitis secondary to organophosphate intoxication is a rare and generally well-course condition, but it is important to be aware of this complication for appropriate clinical management. There are a few reports about this subject in the literature, but it is believed that there are more cases than are reported for this condition. Because symptoms of toxicity can mask this severe complication, we report two cases of acute pancreatitis due to organophosphate intoxication for alerting this condition.
Association of peripapillary fistula with common bile duct stones and cholangitis
(Blackwell Publishing Asia, 2003) Karincaoglu, M; Yildirim, B; Kantarceken, B; Aladag, M; Hilmioglu, F
Background: Peripapillary choledochoduodenal fistula (PCDF) is occasionally detected during endoscopic retrograde cholangiopancreatography. Cholelithiasis and biliary bougienage are two suspected causes of PCDF. Methods: The medical records for 841 patients who underwent endoscopic retrograde cholangiopancreatography between 1993 and 2002 were reviewed for evaluation of PCDF. Results: A total of 327 patients had common bile duct stones, and 16 of these had a PCDF at the papilla of Vater. None of the 16 patients had a history of pancreatitis, duodenal ulcer, or had undergone endoscopic retrograde cholangiopancreatography previously. Seven of the 16 had not undergone biliary surgery. Conclusions: This study indicates that PCDF is a relatively common complication of common bile duct stones and cholangitis. According to the present results, PCDF is more frequently associated with common bile duct stones than with biliary surgery and bougienage.
An attempt to decrease ammonia levels after portacaval anastomosis in dogs - Hepatic periarterial neurectomy
(Kluwer Academic/Plenum Publ, 2002) Yilmaz, S; Kirimlioglu, V; Katz, D; Basak, K; Caglikulekci, M; Kayaalp, C; Yildirim, B
Hepatic encephalopathy and elevated serum ammonia levels occur commonly after portacaval shunt and are hypothesized to be, in part, due to decreased hepatic blood flow. Prior work has demonstrated increased blood flow to the liver following hepatic periarterial neurectomy. In this experimental study, we investigated the functional, hemodynamic, and histopathological changes in the liver and kidney occurring after the addition of hepatic periarterial neurectomy to side-to-side portacaval shunt in dogs. It is our hypothesis that the addition of hepatic periarterial neurectomy to portacaval shunt will decrease postshunt ammonia levels. Side-to-side portacaval shunt was performed in 12 dogs (group I). Hepatic periarterial neurectomy was added to portacaval shunt in 9 dogs (group II). Serum levels of ammonia, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, and bilirubin together with hepatic blood flow were determined in both groups preoperatively and on postoperative day 21. The pre- and postoperative histopathologic changes of the liver and kidney were evaluated. There was significantly less postoperative elevation of serum ammonia and aspartate aminotransferase when hepatic periarterial neurectomy was added to the portacaval shunt procedure. Hemodynamic studies of hepatic artery and hepatic tissue indicated better blood flow in group II. The histopathologic evaluation of group II showed expansion of sinusoids, portal vessels, and portal areas and increased portal fibrosis as compared to group I. The results of this experimental study show that adding hepatic periarterial neurectomy to the portacaval shunt procedure improves postoperative serum levels of ammonia and aspartate aminotransferase and hepatic artery and tissue blood flow.
Brain natriuretic peptide and severity of disease in non-alcoholic cirrhotic patients
(Wiley, 2005) Yildiz, R; Yildirim, B; Karincaoglu, M; Harputluoglu, M; Hilmioglu, F
Background: Cirrhotic patients have a hyperdynamic systemic circulation. They have insidious cardiac problems besides well-known complications. Brain natriuretic peptide (BNP) relaxes vascular smooth muscle and has a portal hypotensive action. The relations between BNP levels and severity of disease, cardiac dysfunction and esophageal varices were studied in non-alcoholic cirrhotic patients. Methods: Fifty-two non-alcoholic cirrhotic patients were evaluated for decompensation component of cirrhosis. The BNP concentration of echocardiographically examined patients was determined. Results: The BNP levels were significantly higher in ascites, spontaneous bacterial peritonitis and hepatic encephalopathy history group (P = 0.033, P < 0.001, P = 0.014, respectively), but no significant difference were observed for presence of esophageal varices and bleeding history (P = 0.267, P = 0.429). A significant correlation was observed between BNP concentration and Child score (r = 0.427, P = 0.012), interventricular septal thickness (r = 0.497, P < 0.001) and left ventricular posterior wall thickness (r = 0.526, P < 0.001). According to Child-Pugh classification there were no significant difference between groups for echocardiographic measurements and blood pressure (P > 0.05), but plasma BNP levels were significantly higher in Child class B and C patients compared with class A patients (P < 0.05). Conclusion: Increased levels of BNP are more likely related to the severity of disease in non-alcoholic cirrhotic patients. The advanced cirrhosis is associated with more advanced cardiac dysfunction and BNP has prognostic value in progression of cirrhosis. (C) 2005 Blackwell Publishing Asia Pty Ltd.
Common bile duct diameters after endoscopic sphincterotomy in patients with common bile duct stones: ultrasonographic evaluation
(Springer-Verlag, 2003) Karincaoglu, M; Yildirim, B; Seckin, Y; Kantarceken, B; Aladag, M; Hilmioglu, F
Background: One of the most reliable, frequently used imaging techniques in cholestasis is ultrasonography (US) for the diagnosis of common bile duct (CBD) stones. Methods: In this study, changes in diameters of CBD were determined ultrasonographically before and after endoscopic sphincterotomy (ES) in 46 patients with stone-induced dilated CBD. Results: There was a significant decrease in CBD diameter measured 1 week after ES and extraction of stone (p < 0.001). In 87% of cases, the difference was more significantly pronounced during the first 24 h of ES. The mean CBD diameters on US were 13.70 +/- 3.00 mm. (10-21 mm) before and 9.13 +/- 2.90 mm (4.2-18 mm) 24 h after endoscopic treatment (p < 0.001). After ES, six patients (13%) with inadequate decreases in CBD diameters were found to have residual stones. Conclusion: US can show residual stones in the CBD with the same efficacy as endoscopic retrograde cholangiopancreatography.
Complement and immunoglobulin levels in serum and ascitic fluid of patients with spontaneous bacterial peritonitis, malignant ascites, and tuberculous peritonitis
(Lippincott Williams & Wilkins, 2002) Yildirim, B; Sari, R; Sezgin, N; Sevinc, A; Hilmioglu, E
Background. We determined complement and immunoglobulin levels in ascitic-fluid and serum of 47 patients with spontaneous bacterial peritonitis, malignant ascites, or tuberculous ascites. Methods. Paracentesis was done to confirm the underlying cause of ascites. Biochemical, hematologic, and microbiologic investigations were also done. Results. The highest serum and ascitic fluid C3 and C4 levels and ascitic fluid IgM, IgA, and IgG levels were found in patients with tuberculosis. Ascitic fluid C3 level was found to be higher in the tuberculous group than in the patients with spontaneous bacterial peritonitis or malignant ascites. Ascitic fluid C4 levels were higher in patients with tuberculosis than in those with spontaneous bacterial peritonitis. Conclusion. We believe that further studies of the in vivo kinetics of immunoglobulins and complement in ascitic fluid of various causes are necessary for a better understanding of the host defense mechanisms of these fluids.
Complete treatment of ruptured hepatic cyst into biliary tree by ERCP
(Springer, 2001) Hilmioglu, F; Karincaoglu, M; Yilmaz, S; Yildirim, B; Kirimlioglu, V; Aladag, M; Onmus, H
[Abstract Not Available]
Does cardiopulmonary bypass alter plasma level of tumor markers? CA 125 and carcinoembryonic antigen
(Georg Thieme Verlag Kg, 2002) Battaloglu, B; Kaya, E; Erdil, N; Nisanoglu, V; Kosar, F; Ozgur, B; Yildirim, B
Background: In addition to malignant diseases, acute and chronic inflammations may elevate plasma levels of tumor markers CA 125 and carcinoembryonic antigen (CEA). Cardiopulmonary bypass (CPB) causes a generalized inflammatory response. In this study, we have investigated the effect of CPB on plasma levels of CA 125 and CEA. Methods: We measured plasma levels of CA 125 and CEA in patients undergoing coronary artery bypass grafting (CABG) with CPB (Group 1, n = 21), and in patients who underwent off-pump CABG, that is, without CPB (Group 2, n = 16). Blood samples were collected preoperatively, and on postoperative days 1, 6, and 12. Results: Within both groups, CEA plasma levels were not significantly influenced in any samples. Comparing with preoperative values, CA 125 values elevated significantly on postoperative days 6 and 12 within both groups. It was observed that the elevation of CA 125 plasma levels in these samples were significantly higher in Group 1. Conclusions: The results indicate that CPB elevated plasma level of CA 125. However, clinical importance of this finding needed further evaluation.
Gallbladder contractility in patients with cirrhotic versus malignant ascites
(Wiley, 2002) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Hilmioglu, F
Purpose. The aim of this study was to evaluate differences in gallbladder contractility by measuring gallbladder wall thickness, fasting and residual gallbladder volume, and gallbladder ejection fraction in patients with cirrhotic and malignant ascites. Methods, Twenty-four patients (16 women and 8 men) with malignant ascites (2 cervical, 2 colon, 2 stomach, 6 pancreatic, and 12 ovarian carcinomas), aged 59 +/- 12 years, and 26 patients (14 women and 12 men) with cirrhotic ascites, aged 57 +/- 16 years, Were included in the study. After patients fasted overnight for 8 hours, gallbladder wall thickness, fasting gallbladder volume, and gallbladder volume and ejection fraction were measured sonographically at 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after ingestion of a standard liquid test meal. Results. The mean gallbladder wall thickness was higher in patients with cirrhotic ascites than in those with malignant ascites (5.5 +/- 1.5 mm [standard deviation] versus 3.1 +/- 0.6 mm, respectively; p < 0.001). The mean fasting gallbladder volume was also higher in patients with cirrhotic ascites than in those with malignant ascites (27.3 +/- 11.5 cm(3) versus 17.6 +/- 8.9 cm(3); p < 0.05). Patients with cirrhotic ascites had significantly higher mean postprandial gallbladder volumes and ejection fractions than did those with malignant ascites at all times except 10 minutes after the meal (p < 0.05). Conclusions. Our findings suggest that gallbladder contractility is greater in patients with cirrhotic ascites than in patients with malignant ascites. (C) 2002 Wiley Periodicals, Inc.
Giant solitary fibrous tumor of the liver with metastasis to the skeletal system successfully treated with trisegmentectomy
(Springer, 2000) Yilmaz, S; Kirimlioglu, V; Ertas, E; Hilmioglu, F; Yildirim, B; Katz, D; Mizrak, B
[Abstract Not Available]
Gluten-free diet improves iron-deficiency anaemia in patients with coeliac disease
(I C D D R B-Centre Health Population Research, 2000) Sari, R; Yildirim, B; Sevinc, A; Buyukberber, S
Two cases of newly-diagnosed asymptomatic coeliac disease with 3 years of unexplained severe iron-deficiency anaemia are presented. Oral iron supplementation had no effect on their serum iron levels and, therefore, had no influence on their anaemia. Upper gastrointestinal endoscopy confirmed normal macroscopic findings, Duodenal biopsies revealed subtotal villous atrophy of the mucosa of the small intestine. A strict gluten-free diet led to an increase in serum iron, resolution of anaemia, and restitution of normal mucosal morphology, Thus, severe iron-deficiency anaemia associated with asymptomatic coeliac disease is responsible to gluten-free diet.
Hepatitis B virus genotype D prevails in patients with persistently elevated or normal ALT levels in Turkey
(Springer Heidelberg, 2004) Yalcin, K; Degertekin, H; Bahcecioglu, IH; Demir, A; Aladag, M; Yildirim, B; Horasanli, S
Background: The clinical relevance of hepatits B virus (HBV) genotypes are poorly understood and it is unclear if the prevalence of HBV genotypes differs with the various clinical features of HBV carriers. The aim of our study was to examine the prevalence of the HBV genotype in a group of patients with chronic hepatitis B, compared to a group with chronic inactive hepatits B surface antigen (HbsAg) carriers. Patients and Methods: HBV genotypes were determined in 32 patients with chronic hepatitis B and in 12 chronic inactive HBsAg carriers. 35 males and nine females with a mean age of 33.95 +/- 13.04 were studied. Serum samples were examined for the presence of HBV DNA by polymerase chain reaction (PIER). Samples negative in first round PCR were further amplified with nested PCR. The PCR product was sequenced with the Cy5/5.5 dye primer kit on a Long Read Tower automated DNA sequencer. Results: HBV DNA was detectable in 29 (66%) and 44 (100%) patients by the PCR with universal primers and nested-PCR, respectively. All patients were found to be infected with HBV genotype D. Genotype D was the only detected type found in different clinical forms of chronic HBV infection, in all hepatitis B e antigen (HbeAg)-positive and negative patients, in at[ patients who had elevated or normal alanine transaminase (ALT) Levels and in all ages. Conclusion: In the present study we could not find any association between genotype D and distinct clinical phenotypes. Genotype D is the predominant type among hepatitis B carriers residing in our region and is not associated with more severe liver diseases. This genotype did not influence clinical manifestations in carriers with chronic hepatitis B virus infection. However, additional Large-scale longitudinal studies are needed to find the relationship of HBV genotypes to liver disease severity and clinical outcomes.
The importance of serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, and CA 15-3 levels in differential diagnosis of ascites etiology
(H G E Update Medical Publishing S A, 2001) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Hilmioglu, F
Background/Aims: Clinical usage of tumor markers is being limited due to low specificity. Elevated plasma levels of tumor markers may be seen in diseases other than malignancy, i.e., kidney, liver or circulatory disturbances. Methodology: In our study, we studied serum and ascites fluid alpha-fetoprotein, carcinoembryonic antigen, CA 19-9, CA 15-3 levels in patients with chronic liver disease, spontaneous bacterial peritonitis, malignancy, tuberculous and congestive heart failure in a total of 76 patients. Results: The sensitivity and specificity for ascites fluid alpha-fetoprotein levels were 28.5% and 100%, for serum alpha-fetoprotein levels 28.5% and 98.1%, for ascites fluid carcinoembryonic antigen levels 38.0% and 98.1%, for serum carcinoembryonic antigen levels 57.1% and 90.0%, for ascites fluid CA 19-9 levels 19.0% and 94.5%, for serum CA 19-9 levels 33.3% and 21.8%, for ascites fluid CA 15-3 levels 28.5% and 92.7%, and for serum CA 15-3 levels 47.6% and 81.8%, respectively. Conclusions: In conclusion, the sensitivity of serum and ascites fluid tumor markers was found to be low. High specificity may be due to low number of study participants. Serum and ascites fluid tumor markers are not found to be useful in the differential diagnosis of ascites etiology.
Interval analysis in patients with acute biliary pancreatitis
(Lippincott Williams & Wilkins, 2005) Ates, F; Kosar, F; Aksoy, Y; Yildirim, B; Sahin, I; Hilmioglu, F
Background: It has been previously proposed that electrocardiographic abnormalities may be associated with acute pancreatitis. However, there is a lack of data on the QT interval and dispersion value in patients with acute pancreatitis, and no data are also available concerning QT interval and QT dispersion in acute biliary pancreatitis ( ABP). Aims: We aimed to investigate the QT parameters in patients with ABP, to compare them with those of healthy controls, and to analyze the relationship between QT parameters and Ranson score. Methods: The present study included 32 patients with acute biliary pancreatitis and 35 healthy controls. The severity of the pancreatitis was determined by Atlanta criteria: fewer than 3 Ranson criteria or fewer than 8 APACHE II ( the Acute Physiology and Chronic Health Evaluation) points indicated the mild disease ( group 1); 3 or more Ranson criteria or 8 or more APACHE II points or organ failure or systemic complications or local complications indicated the severe disease ( group 2). On admission, all patients underwent a standard 12-lead electrocardiogram, and corrected maximum QTc interval (QTc(max)), corrected minimum QT interval (QTc(min)), and corrected QTc dispersion (QTcd) values of the subjects were measured according to the Bazett formula in this study. Results: QTc(max) and QTcd were significantly longer in patients with ABP than in healthy controls ( 442 6 38 milliseconds versus 413 6 34 milliseconds, P< 0.05; and 67 +/- 21 milliseconds versus 42 +/- 18 milliseconds, P< 0.001, respectively). Similarly, QTc(max) and QTcd were significantly longer in group 2 than in group 1 ( 440 6 38 milliseconds versus 450 +/- 34 milliseconds, P< 0.01; and 66 +/- 9 milliseconds versus 71 +/- 11 milliseconds, P< 0.01, respectively). Correlation analysis showed that there is a significant positive relationship between Ranson scores of patients and QTcmax and QTcd ( P< 0.01 and P< 0.001, respectively). Conclusion: The effect of acute biliary pancreatitis on QT intervals and dispersion appears to be dependent not only on the disease but also on its severity, and these parameters may give additional prognostic information in ABP patients, even in the initial evaluation.
Memory impairment in patients with cirrhosis
(Natl Med Assoc, 2005) Bahceci, F; Yildirim, B; Karincaoglu, M; Dogan, I; Sipahi, B
Background and Aim: Subdinical hepatic encephalopathy (HE) in cirrhotic patients is usually characterized by memory impairment and psychomotor slowing. Our aim was to investigate memory status in cirrhotic patients with and without clinically overt HE. Material and Methods: Thirty-two cirrhotic patients (10 female and 22 male) aged 49 17 years and 20 healthy subjects (six female and 14 male) aged 46 12 years were included in the study. Memory status was defined by Wechsler Memory Scale, verbal memory process and complex memory process tests. Results: Grade-1 HE was detected in 7 (22%) patients with cirrhosis. We detected 36 to 92% decrement in various memory tests in cirrhotic patients without HE as compared to healthy subjects. The scores for all psychometric testing results were significantly lower in cirrhotic patients without HE as compared to healthy subjects. We detected 42.9 to 100% decrement in various memory tests in cirrhotic patients with HE than cirrhotic patients without HE. However, there was no statistical significant difference between cirrhotic patients with and without HE. There was no statistical significant difference in cirrhotic patients with Child-Pugh A, B, and C. Conclusion: In conclusion, memory status was influenced in which patients with cirrhosis yet has a normal mental and neurological status to routine clinical examination (subclinical HE). Occasionally, decreased memory performance may adversely affect the satisfaction and lifestyle of these patients. Therefore, subclinical HE is an important social problem.
The pathological examinations of gastric mucosa in patients with Helicobacter pylori-positive and -negative pernicious anemia
(Blackwell Science Inc, 2000) Sari, R; Ozen, S; Aydogdu, I; Yildirim, B; Sevinc, A
Background. The basic histopathological finding in gastric mucosa is chronic atrophic gastritis in patients with pernicious anemia. Materials and Methods. We evaluated the frequency of Helicobacter pylori and pathological examinations of gastric mucosa in pernicious anemia (n = 30) by endoscopical findings and biopsy. The results were compared with gastric mucosa specimens of patients with H. pylori-positive nonulcer dyspepsia (n = 36) and H. pylori-negative nonulcer dyspepsia (n = 21). Results. H. pylori was diagnosed in 12 patients (40%) with pernicious anemia. Fundal biopsy examinations showed atrophic gastritis in 30 patients (100%), intestinal metaplasia in 13 patients (43.3%), lymphoid follicle in 15 patients (50%), and dysplasia in 6 patients (20%). Antral biopsy examinations showed atrophic gastritis in 8 patients (26.6%), intestinal metaplasia in 8 patients (26.6%), lymphoid follicle in 8 patients (26.6%), and dysplasia in 3 patients (10%). The frequency of fundal inflammation, atrophy, intestinal metaplasia, lymphoid follicle, and dysplasia and antral intestinal metaplasia and mild antral dysplasia were found to be higher in those in the pernicious anemia group than in the nonulcer dyspeptic patients. Antral inflammation, atrophy, and moderate and severe antral dysplasia were found to be higher in chose in the nonulcer dyspeptic group. Conclusions. Particularly, fundal precancerous lesions were found to be more frequent in patients with pernicious anemia independent of H. pylori.
Patients with spontaneous bacterial peritonitis, and malignant and cirrhotic ascites
(Natl Med Assoc, 2005) Yildirim, B; Sari, R; Isci, N
Background: Cytokines play a key role in the regulation of cells of the immune system and also have been implicated in the pathogenesis of malignant diseases. Method and Patients: We studied tumor necrosis factor-cl, tumor necrosis factor receptor and C-reactive protein levels in both ascitic fluid and serum in patients with spontaneous bacterial peritonitis (SBP) (n=22), and in the malignant (n=38) and cirrhotic (n=32) ascites. Results: C-reactive protein, tumor necrosis factor-a and tumor necrosis factor receptor levels in the ascitic fluid were found to be elevated in the SBP (p<0.001) and malignant groups (p<0.005) when compared with the sterile cirrhotic group. C-reactive protein levels in the serum were found to be elevated in the SBP group when compared with the sterile cirrhotic (p<0.001) and malignant group (p<0.005). Tumor necrosis factor-a in the serum was significantly elevated in the SBP when compared with the cirrhotic (p<0.005) and malignant ascites (p<0.001). Sensitivity and specificity of ascitic fluid CRP in discriminating malignant 84% and 67% and SBP from sterile ascites were 90% and 76%, respectively. Sensitivity and specificity of ascitic fluid TNF-alpha in discriminating malignant 77% and 60% and SBP from sterile ascites were 82% and 66%, respectively. Sensitivity and specificity of TNF-r p60 in discriminating malignant 74% and 70% and SBP from sterile ascites were 80% and 76%, respectively. Conclusion: The sensitivity and specificity of ascitic fluid CRP, TNF-alpha and TNF-r values were found to be similar. Ascitic fluid C-reactive protein to differentiate SBP and malignant ascitic from cirrhotic ascites are cheap, practical and safe tests used in the differential diagnosis of ascites.
Re.: Zuckerman et al. -: Sensitivity of Ca-125 in patients with liver cirrhosis in the presence of ascites
(Lippincott Williams & Wilkins, 2001) Sari, R; Yildirim, B; Sevinc, A; Hilmioglu, F
[Abstract Not Available]
Serum and ascites fluid cytokine levels in patients with chronic heart failure
(Acta Cardiologica, 2001) Sari, R; Yildirim, B; Sevinc, A; Bahceci, F; Ozdemir, R; Hilmioglu, F
Objective - Cytokines that are capable of modulating cardiovascular function were reported to be elevated in patients with advanced heart failure. We evaluated the diagnostic importance of cytokines both in the serum and ascites. Material and methods - We determined serum and ascites fluid TNF-alpha, IL-1 beta, IL-6, IL-8, and soluble IL-2 receptor levels in 14 patients with congestive heart failure (group I) and in 15 patients with chronic liver disease (group 2). Results - Ascites fluid IL-8 and soluble IL-2 receptor levels were found to be significantly elevated in group I when compared with group 2 (p = 0.014 and p = 0.005). There were no statistical differences in serum TNF-alpha, IL-1 beta, IL-6, IL-8, and soluble IL-2 receptor levels and ascites fluid TNF-alpha, 1L- I (IL-1 beta, and IL-6 Ievels. Ascites fluid/serum IL- I (IL-1 beta and IL-8 ratio was lower in group 1 when compared with group 2 (p = 0.001 and p = 0.005). Ascites fluid/serum IL-2 and IL-6 ratio was higher in group I when compared with group 2 (p = 0.035 and p = 0.025). Conclusion - Cytokine levels in ascites fluid, but not in serum, are important in congestive heart failure. Ascites fluid/serum cytokine level ratios were detected to be more conclusive and valid in the diagnosis work-up of ascites aetiology.
Serum and gastric fluid levels of cytokines and nitrates in gastric diseases infected with Helicobacter pylori
(Luigi Ponzio E Figlio, 2004) Mehmet, N; Refik, M; Harputluoglu, M; Ersoy, Y; Aydin, NE; Yildirim, B
This case control study presents data on the concentrations of nitrite and nitrate and a variety of pro-inflammatory cytokines such as interleukin-1beta (IL-1beta), interleukin-2R (IL-2R), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor TNF-alpha in gastric fluid and serum. Patients with gastritis, gastric ulcer and gastric cancer are studied and grouped according to infection by Helicobacter pylori. The 208 patients who underwent tipper gastrointestinal endoscopic examination were classified as follows; H. pylori-positive gastritis (n=32), H. pylori-negative gastritis (n=32), H. pylori-positive ulcers (n=34), H. pylori-negative ulcers (n=34), 43 patients with H. pylori-positive gastric cancer in addition to 33 H. pylori-negative healthy control individuals. Gastric fluids and blood samples were taken concomitantly. Cytokines and nitrite and nitrate determinations were attempted as soon as possible after collection of the samples. Nitrite and nitrate levels of serum and gastric fluids of H. pylori-positive gastritis and ulcers were higher than H. pylori-negative gastritis and ulcers. The concentrations of total nitrite and nitrate and cytokines (TNF-alpha IL-2R, IL-6, and IL-8) in gastric fluids and sera of H. pylori-positive gastric cancer patients were higher than H. pylori-negative control groups. IL-1beta level was significantly elevated in gastric fluid of infected cancer patients but not in serum. Taken together, the results suggest that an increase in cytokine-NO combination in gastric mucosa previously reported by many studies is not restricted to local infected gastric tissue but also detected in gastric fluid and sera of H. pylori-positive subjects and may have an important role in the pathogenesis and development of common gastric diseases.

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