The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography

BACKGROUND:Mirizzi syndrome is a rare complication of cholelithiasis,characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct.In this study,we aimed to describe the clinical presentations,investigations,operative details,and complications of seven patients who underwent endoscopic retrograde cholangiopancreatography and were finally diagnosed with Mirizzi syndrome in our center. METHOD:We performed a retrospective analysis of the records of 7 patients with Mirizzi syndrome who underwent endoscopic retrograde cholangiopancreatography. RESULTS:The incidence of Mirizzi syndrome was 1.07% of 656 patients given endoscopic retrograde cholangiopan- creatography.Ultrasonography was able to diagnose one case.Endoscopic retrograde cholangiopancreatography suggested the diagnosis in five cases and helped further in the management of these patients.Four patients had cholecystectomy and T-tube placement,and two had cholecystectomy and choledochoduodenostomy.One patient with typeⅠMirizzi syndrome according to the Csendes classification successfully underwent laparoscopic cholecystectomy. CONCLUSIONS:In the study,the incidence of Mirizzi syndrome was 1.07%of patients who underwent endoscopic retrograde cholangiopancreatography. Preoperative diagnosis of Mirizzi syndrome by endoscopicretrograde cholangiopancreatography is important to prevent complications.

H pylori iceA alleles are disease-specific virulence factors

AIM： To characterize and compare genotype profiles of H pylori strains isolated from patients with chronic gastritis and duodenal ulcer in western part of Turkey. METHODS： A total of 46 patients [30 chronic gastritis （CG） and 16 duodenal ulcer （DU）] who had undergone endoscopy because of dyspeptic complaints were studied. The antral biopsy specimens were evaluated for the presence of Hpylori by rapid urease test and culture, and the genotype profiles were determined by real-time PCR. RESULTS： The cagA gene was observed in 43 （93.5%） isolates. The vacA s1m2 genotype was the predominant subtype, found in 63.3% and 68.7% of isolates in patients with CG and DU, respectively. Twenty （66.6%） isolates from patients with CG were iceA2 positive while the iceA1 was predominant in those with DU （68.8%）. In terms of the association of the ice,4 alleles to other genes, both alleles were significantly associated with the cagA vacA slm2 genotype. CONCLUSION： The prevalent circulating genotypes in CG and DU were cagA vacA slm2 iceA2 and cagA vacA slm2 iceA1 genotype, respectively. It was found that cagA vacA slm2 genotype seems to be common virulence factors in both CG and DU while iceA alleles show specificity for gastroduodenal pathologies in this study.

Scintigraphic evaluation of gallbladder motor functions in H pylori positive and negative patients in the stomach with dyspepsia

AIM:To evaluate the relationship between gallbladder (GB) motor function and H pylori infection in the stomach. METHODS: All cases (86) underwent the 14C urea breath test (UBT). 14C-UBT was found as positive in 58 and negative in 28 dyspeptic patients. 14C- UBT was accepted as a gold standard test. Clo test and histopathologic examination were compared with the results of 14C-UBT in cases who tolerated upper gastrointestinal endoscopy procedure. Cholescintigraphy with 99mTc-mebrofenin was used to determine the parameters of GB motor function (GB filling and emptying time, half of the emptying time, ejection fraction at 30th and 60th min) in all patients. RESULTS: We found the sensitivity and specificity as 88% and 86% for Clo test and as 89% and 80% for histologic evaluation, respectively. The parameters of GB function were not significantly different in H pylori positive and negative patients. The GB emptying was normal in both groups. Minimum GB filling time was 30 min in 34 of 86 cases (39.5%), filling was not observed in 2 cases. The GB ultrasonography (USG) results were normal for all cases and bile composition abnormality was not determined.CONCLUSION: Our study showed that 14C-UBT is highly reliable method to detect the presence of H pylori. The presence of H pylori infection does not directly affect the GB function.

A case of mediastinal mesenchymal tumor resembling hemopericardium

Mediastinal neoplasms are rare in the elderly,and clinical suspicion is the first and most important step of differential diagnosis.Mediastinal tumors can be misdiagnosed because their symptoms or signs can overlap with cardiovascular diseases,which have a higher prevalence among the older population.The diagnostic process should be managed with multimodality imaging and clinical judgement.Here,the case of a 74-year-old male patient,who presented with shortness of breath,is examined.A chest X-ray revealed an increased cardiothoracic ratio,and he was diagnosed with hemopericardium following an emergent chest computed tomography.In the echocardiography,it was suspected that a hyperechogenic area adjacent to the heart might be due to a mass,and further examinations confirmed a mediastinal neoplasm.A surgical biopsy was performed,and it was determined to be a mesenchymal tumor.To conclude,clinicians should keep in mind the possibility of paracardiac neoplasm in the elderly,as well as in other age groups,when encountering mediastinal widening so that the patient can be protected from unnecessary interventions such as pericardiocentesis.

The Importance of Occupational Health and Safety(OHS)and OHS Budgeting in terms of Social Sustainability in the Construction Sector

Nowadays,sustainability is one of the most important construction sector goals,as it is in most other sectors.However,sustainability in the construction sector is dealt mostly with its environmental and economic dimensions,and its social dimension remains in the background.This situation causes the Occupational Health and Safety(OHS),which is perhaps the most important issue within the scope of social sustainability,to be addressed on its own,and its relationship with sustainability to be not introduced clearly.This study discussed the relationship between social sustainability and OHS in the construction sector.Based on the fact that in construction projects,the sustainability goal should be revealed forward to a great extent at the design stage,how to contribute to OHS by budgeting OHS activities together with project activities was explained.We intended to contribute to the provision of OHS and thus the social sustainability of construction projects by revealing how the budgeting will be done and how much OHS budget will be,by referring to the studies in the literature conducted about OHS budgeting and presented robust numerical data.The study is expected to help construction sector stakeholders to understand the relationship between social sustainability and OHS and to provide a clear picture of the role of budgeting in this respect.

Low serum neutralizing anti-SARS-CoV-2 S antibody levels in mildly affected COVID-19 convalescent patients revealed by two different detection methods

Neutralizing antibodies targeting the receptor-binding domain(RBD)of the SARS-CoV-2 spike(S)block severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)entry into cells via surface-expressed angiotensin-converting enzyme 2(ACE2).We used a surrogate virus neutralization test(sVNT)and SARS-CoV-2 S protein-pseudotyped vesicular stomatitis virus(VSV)vector-based neutralization assay(pVNT)to assess the degree to which serum antibodies from coronavirus disease 2019(COVID-19)convalescent patients interfere with the binding of SARS-CoV-2 S to ACE2.Both tests revealed neutralizing anti-SARS-CoV-2 S antibodies in the sera of ~90% of mildly and 100% of severely affected COVID-19 convalescent patients.Importantly,sVNT and pVNT results correlated strongly with each other and to the levels of anti-SARS-CoV-2 S1 IgG and IgA antibodies.Moreover,levels of neutralizing antibodies correlated with the duration and severity of clinical symptoms but not with patient age.Compared to pVNT,sVNT is less sophisticated and does not require any biosafety labs.Since this assay is also much faster and cheaper,sVNT will not only be important for evaluating the prevalence of neutralizing antibodies in a population but also for identifying promising plasma donors for successful passive antibody therapy.