Objective: We evaluated the efficiency of 3-dimensional Computed Tomographic Angiography (3D CTA) performed with 64-channel Multidetector Computed Tomography (MDCT) to assess vascular anatomy before laparoscopic gastrectomy.

Material and method: 20 patients with early gastric cancer scheduled for laparoscopic gastrectomy were evaluated. Dual phase IV contrast CTA was performed before laparoscopic gastrectomy. Arterial and venous phase images were obtained after rapid infusion of contrast agent with an interval of 15 seconds serially during single breath hold of 31 seconds.

Results: In all patients, 3D CTA showed Left Gastric Artery (LGA), Left Hepatic Artery (LHA), Right Gastric Artery (RGA) and Left Coronary Vein (LCV) with celiac trunk. Celiac trunk branching pattern was classified according to Michel’s method and in 18 cases, Michel’s type 1, in 2 cases Michel’s type 2 were identified. RGA was originated from Gastro Duodenal Artery (GDA) in 16 cases, from Superior Mesenteric Artery (SMA) in 2 cases and from Proper Hepatic Artery (PHA) in 2 cases. LCV was draining into Superior Mesenteric Vein (SMV) in 18 cases and into Portal Vein (PV) in 2 cases. In 12 of the cases LCV was coursing dorsal to PHA, Common Hepatic Artery (CHA) and Splenic Artery (SA), in 6 cases LCV was coursing ventral to these vessels and was joined to SMV. In 2 cases whose LCV was draining into PV, it was coursing ventral to CHA.

Conclusion: Dual phase CTA is successful to define perigastric vascular structures and reduces the risk of vascular injuries when performed before laparoscopic gastrectomy.

Systemic lupus erythematosus (SLE) is a multisystem disease, that may affect multiple organ systems in the body. As a rare initial presentation of SLE, acute pancreatitis presents as generalized flare-ups in most cases of patients previously diagnosed with SLE. Here we report a rare case of acute pancreatitis and pancytopenia as the initial presentation of systematic lupus erythematosus.

15 year old female patient presented with chief complaints of abdominal pain, nausea, vomiting and non bloody diarrhea. The onset of abdominal pain started 4 days prior to admission, localizing to the right upper quadrant on day 2. Associated symptoms consisted of nonbloody diarrhea and nonbloody/nonbilious vomit for 4 days. There was no contributory past medical history or past surgical history. Patient denies any drug allergies. On general physical examination, a fine lacy rash was noted on all four extremities. Her vitals were T 37.9, HR 104, RR 18, BP 99/58. No guarding/rigidity and no masses or organomegaly were appreciated. CBC revealed profound pancytopenia with a platelet count of 115 (150-400 x10³/uL), hemoglobin 8.5 (12-15 g/dL) and white blood cell 1.5 (4.5-13 x10³/uL). Lipase was 489 u/L and Lactate Dehydrogenase was 2392 u/L. Other laboratories, including comprehensive metabolic panel, lipid panel, C-reactive protein, and pregnancy test, were all within normal limits. Patient was admitted with diagnosis of pancreatitis with pancytopenia and supportive treatment with investigative studies was initiated. Bone marrow biopsy was unequivocal. Infectious Disease was consulted. New laboratory test results indicated positive IgG and IgM antibodies to Brucella, Rickettsia, Ebstein Barr Virus and Parvovirus, complicating the diagnosis. Patient started on doxycycline empirically. Rheumatology consulted most likely etiology to be SLE and await Lupus Panel Results. Erythrocyte sedimentation rate was 74 mm/hr, positive antinuclear antibody (ANA) 1/640, positive anti doublestranded DNA Antibody 1/320, positive anti Smith antibody, negative rheumatoid factor, C3 <40mg/dL, Lipase 2784 u/L, fecal occult bkood test positive. Following lab results and clinical course, the diagnosis of Systemic Lupus Erythematosus was made on day 4 of admission. Steroids were initiated, and the patient’s status was observed closely. Lipase continued to rise to 8,136 u/L which prompted an MRCP. MRCP showed extensive changes of pancreatitis with upper abdominal fluid, no organized collection or dilation of ducts. Also noted was extensive wall edema of the gallbladder with no filling defect. Lipase began trending down on day 2 of steroids. CBC corrected to within normal limits. Patient reported feeling better and continued improving.

This case aims to facilitate diagnosticians in their evaluation of patients presenting with rare manifestations of SLE. SLE should be considered in cases of pancreatitis when common etiologies have been ruled out and symptoms are not residing despite appropriate treatment. In regards to hematologic abnormalities, SLE can cause various cytopenias as an initial presentation but pancytopenia has been reported fewer times in the literature.

Many diseases occur at certain times and after specific process. Their treatment also needs to be done at a certain time. There are seasonal time and environments that make up the diseases. In parallel with the type of the disease, their treatment also requires a specific process and period. Treatments not made at the right time and in the right place do not yield results. The aim of this study is to show that treatment of diseases is related to the biological clock and the circadian rhythm. In our study, classical medical data and modern medical studies were evaluated together. Eclectic method is used in the article. In our study, there are no astrological data. There are many factors that affect human health, from his/her own environment to the outside atmosphere such as sun and moon. In the direction of this study, it is found out that there are certain times of day and night for the treatment of diseases. Based on our study, the most convenient time zones for the treatment of diseases are the last one-third of the day and night times. Accordingly, the most convenient times for the treatments are the time zones which are before sunrise close to sunset. It should not be forgotten that this situation may change according to summer and winter and to the countries in the direction of latitude and longitude. The theses in our study offers theoretical information for future research. We believe that the data here will be a key resource for subsequent experiment-based studies.

Helicobacter pylori (H.pylori) infection is the most common cause of peptic ulcer disease and it can be associated with many complications including some malignancies. The treatment of this bacteria that colonizes the mucous layer of the gastric epithelium in more than half of the world’s population remains a challenge.

The guided treatments for H.pylori nowadays rely on a mixture of antibiotics with anti-acid-secretory agents in the forms of triple, quadruple or other eradication regimens. Some clinicians use clavulanic acid (CA) by conceptual mistake (habit, assumption of similar resistance mechanisms between H.pylori and streptococcus, or prescribing amoxicillin + clauvanate as an alternative to amoxicillin) and some others suppose that it may be effective in combination with other antibiotics or as addition to some regimens used for H.pylori eradication.

The in vivo and in vitro effects of CA on a variety of bacteria including H.pylori, the human body physiological changes in response to CA treatment, CA as a neurotransmitter modulating agent, and the clinical evidence of its effectiveness against H.pylori infection were reviewed comprehensively to assess whether CA has a potential benefit as an additive to the guided eradication regimens for H.pylori infection. Concomitantly, this may pave the way for new avenues in the management of peptic ulcer disease and H.pylori infection. A summary of the studies conducted at our institute regarding peptic ulcer disease will be presented as well.

Many diseases occur at certain times and after specific process. Their treatment also needs to be done at a certain time. There are seasonal time and environments that make up the diseases. In parallel with the type of the disease, their treatment also requires a specific process and period. Treatments not made at the right time and in the right place do not yield results. The aim of this study is to show that treatment of diseases is related to the biological clock and the circadian rhythm. In our study, classical medical data and modern medical studies were evaluated together. Eclectic method is used in the article. In our study, there are no astrological data. There are many factors that affect human health, from his/her own environment to the outside atmosphere such as sun and moon. In the direction of this study, it is found out that there are certain times of day and night for the treatment of diseases. Based on our study, the most convenient time zones for the treatment of diseases are the last one-third of the day and night times. Accordingly, the most convenient times for the treatments are the time zones which are before sunrise close to sunset. It should not be forgotten that this situation may change according to summer and winter and to the countries in the direction of latitude and longitude. The theses in our study offers theoretical information for future research. We believe that the data here will be a key resource for subsequent experiment-based studies.

There is increasing evidences that favor the prenatal beginning of schizophrenia. These evidences point toward intra-uterine environmental factors that act specifically during the second pregnancy trimester producing a direct damage of the brain of the fetus. The current available technology doesn't allow observing what is happening at cellular level since the human brain is not exposed to a direct analysis in that stage of the life in subjects at high risk of developing schizophrenia. Methods. In 1977 we began a direct electron microscopic research of the brain of fetuses at high risk from schizophrenic mothers in order to finding differences at cellular level in relation to controls. Results. In these studies we have observed within the nuclei of neurons the presence of complete and incomplete viral particles that reacted in positive form with antibodies to herpes simplex hominis type I [HSV1] virus, and mitochondria alterations. Conclusion. The importance of these findings can have practical applications in the prevention of the illness keeping in mind its direct relation to the aetiology and physiopathology of schizophrenia. A study of the gametes or the amniotic fluid cells in women at risk of having a schizophrenic offspring is considered. Of being observed the same alterations that those observed previously in the cells of the brain of the studied foetuses, it would intend to these women in risk of having a schizophrenia descendant, previous information of the results, the voluntary medical interruption of the pregnancy or an early anti HSV1 viral treatment as preventive measure of the later development of the illness.