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Published in: Digestive Diseases and Sciences 5/2008

01-05-2008 | Original Paper

Comparative Effects of Several Therapatic Agents on Hepatic Damage Induced by Acute Experimental Pancreatitis

Authors: Mukaddes Eşrefoğlu, Mehmet Gül, Fahri Turan

Published in: Digestive Diseases and Sciences | Issue 5/2008

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Abstract

Purpose The prognosis of acute pancreatitis (AP) depends upon the degree of pancreatic necrosis and the intensity of multisystem organ failure. The liver contributes to the systemic manifestations of AP by releasing some cytokines. This study was undertaken to examine comparative effects of melatonin, antioxidant mixture containing L(+)-ascorbic acid and N-acetyl cysteine, pentoxifylline and l-arginine on hepatic damage induced by caerulein-pancreatitis. Results The liver specimens of all groups showed histopathological alterations such as hepatocyte necrosis, intracellular vacuolization, vascular congestion, sinusoidal dilatation and inflammatory infiltration. TEM studies revealed vacuole formation, mitochondrial degeneration, lysosome accumulation and necrosis. The mean histopathological score of the caerulein group was significantly different from that of each treatment group. Conclusion l-Arginine and antioxidant administration be important for reducing hepatic damage induced by AP. Improvement of hepatic damage, in turn, might be beneficial for the prognosis of AP.
Literature
1.
go back to reference Esrefoglu M, Gul M, Ates B, Yilmaz I (2006) Ultrastructural clues for the protective effect of ascorbic acid and N-acetylcysteine against oxidative damage on caerulein-induced pancreatitis. Pancreatology 6:477–485PubMedCrossRef Esrefoglu M, Gul M, Ates B, Yilmaz I (2006) Ultrastructural clues for the protective effect of ascorbic acid and N-acetylcysteine against oxidative damage on caerulein-induced pancreatitis. Pancreatology 6:477–485PubMedCrossRef
2.
go back to reference Esrefoglu M, Gul M, Ates B, Batcioglu K, Selimoglu MA (2006) Antioxidative effect of melatonin, ascorbic acid and N-acetylcysteine on caerulein-induced pancreatitis and associated liver injury in rats. World J Gastroenterol 12:259–264PubMed Esrefoglu M, Gul M, Ates B, Batcioglu K, Selimoglu MA (2006) Antioxidative effect of melatonin, ascorbic acid and N-acetylcysteine on caerulein-induced pancreatitis and associated liver injury in rats. World J Gastroenterol 12:259–264PubMed
3.
go back to reference Zyromski N, Murr MM (2003) Evolving concepts in the pathopysiology of acute pancreatitis. Surgery 133:235–237PubMedCrossRef Zyromski N, Murr MM (2003) Evolving concepts in the pathopysiology of acute pancreatitis. Surgery 133:235–237PubMedCrossRef
4.
go back to reference Steer ML, Saluja AK (1993) Etiology and pathophysiology of acute pancreatitits In: Go VLW, DiMagno EP, Gardner JD, Lebenthal E, Rebar HA, Scheele GA (eds) The pancreas: biology, patholophysiology and disease. Raven Press, New York, pp 593–611 Steer ML, Saluja AK (1993) Etiology and pathophysiology of acute pancreatitits In: Go VLW, DiMagno EP, Gardner JD, Lebenthal E, Rebar HA, Scheele GA (eds) The pancreas: biology, patholophysiology and disease. Raven Press, New York, pp 593–611
5.
go back to reference Esrefoglu M, Gul M, Ates B, Selimoglu MA (2006) Ultrastructural clues for the protective effect of melatonin against oxidative damage in cerulein-induced pancreatitis. J Pineal Res 40:92–97PubMedCrossRef Esrefoglu M, Gul M, Ates B, Selimoglu MA (2006) Ultrastructural clues for the protective effect of melatonin against oxidative damage in cerulein-induced pancreatitis. J Pineal Res 40:92–97PubMedCrossRef
6.
go back to reference Rau B, Poch B, Gansauge F, Bauer A, Nussler AK, Nevalainen T, Schoenberg MH, Beger HG (2000) Pathophysiologic role of oxygen free radicals in acute pancreatitis: initiating event or mediator of tissue damage? Ann Surg 231:352–360PubMedCrossRef Rau B, Poch B, Gansauge F, Bauer A, Nussler AK, Nevalainen T, Schoenberg MH, Beger HG (2000) Pathophysiologic role of oxygen free radicals in acute pancreatitis: initiating event or mediator of tissue damage? Ann Surg 231:352–360PubMedCrossRef
7.
go back to reference Ueda T, Ho HS, Anderson SE, Takeyama Y (1999) Pancreatitis-induced ascitic fluid and hepatocellular dysfunction in severe acute pancreatitis. J Surg Res 82:305–311PubMedCrossRef Ueda T, Ho HS, Anderson SE, Takeyama Y (1999) Pancreatitis-induced ascitic fluid and hepatocellular dysfunction in severe acute pancreatitis. J Surg Res 82:305–311PubMedCrossRef
8.
go back to reference Folch-Puy E (2007) Importance of the liver in systemic complications associated with acute pancreatitis: the role of Kupffer cells. J Pathol 211:383–388PubMedCrossRef Folch-Puy E (2007) Importance of the liver in systemic complications associated with acute pancreatitis: the role of Kupffer cells. J Pathol 211:383–388PubMedCrossRef
9.
go back to reference Watanabe O, Baccino FM, Steer ML, Meldolesi J (1984) Supramaximal caerulein stimulation and ultrastructure of rat pancreatic acinar cell: early morphological changes during development of experimental pancreatitis. Am J Physiol 246:G457–G467PubMed Watanabe O, Baccino FM, Steer ML, Meldolesi J (1984) Supramaximal caerulein stimulation and ultrastructure of rat pancreatic acinar cell: early morphological changes during development of experimental pancreatitis. Am J Physiol 246:G457–G467PubMed
10.
go back to reference Andrzejewska A, Dlugosz JW, Jurkowska G (1998) The liver ultrastructure in caerulein and taurocholate acute pancreatitis in the rats. Rocz Akad Med Bialymst 43:117–136PubMed Andrzejewska A, Dlugosz JW, Jurkowska G (1998) The liver ultrastructure in caerulein and taurocholate acute pancreatitis in the rats. Rocz Akad Med Bialymst 43:117–136PubMed
11.
go back to reference Beger HG, Rau B, Mayer J, Pralle U (1997) Natural coarse of acute pancreatitis. World J Surg 21:130–135PubMedCrossRef Beger HG, Rau B, Mayer J, Pralle U (1997) Natural coarse of acute pancreatitis. World J Surg 21:130–135PubMedCrossRef
12.
go back to reference Grewal HP, Garland L, Novak K, Gaber L, Tolley EA, Gaber AO (1993) Risk factors for postimplantation pancreatitis and pancreatic thrombosis in pancreas transplant recipients. Transplantation 56:609–612PubMedCrossRef Grewal HP, Garland L, Novak K, Gaber L, Tolley EA, Gaber AO (1993) Risk factors for postimplantation pancreatitis and pancreatic thrombosis in pancreas transplant recipients. Transplantation 56:609–612PubMedCrossRef
13.
go back to reference Laskin DL, Weinberger B, Laskin JD (2001) Functional heterogenity in liver and lung macrophages. J Leukoc Biol 70:163–170PubMed Laskin DL, Weinberger B, Laskin JD (2001) Functional heterogenity in liver and lung macrophages. J Leukoc Biol 70:163–170PubMed
14.
go back to reference Kmiec Z (2001) Cooperation of liver cells in health and disease. Adv Anat Embryol Cell Biol 161:1–115 Kmiec Z (2001) Cooperation of liver cells in health and disease. Adv Anat Embryol Cell Biol 161:1–115
15.
go back to reference Grewal HP, Kotb M, el Din AM, Ohman M, Salem A, Gaber L, Gaber AO (1994) Induction of tumor necrosis factor in severe acute pancreatitis and its subsequent reduction after hepatic passage. Surgery 115:213–221PubMed Grewal HP, Kotb M, el Din AM, Ohman M, Salem A, Gaber L, Gaber AO (1994) Induction of tumor necrosis factor in severe acute pancreatitis and its subsequent reduction after hepatic passage. Surgery 115:213–221PubMed
16.
go back to reference Pereda J, Sabater L, Aparisi L, Escobar J, Sandoval J, Vina J, Lopez-Rodas G, Sastre J (2006) Interaction between cytokines and oxidative stress in acute pancreatitis. Curr Med Chem 13:2775–1787PubMedCrossRef Pereda J, Sabater L, Aparisi L, Escobar J, Sandoval J, Vina J, Lopez-Rodas G, Sastre J (2006) Interaction between cytokines and oxidative stress in acute pancreatitis. Curr Med Chem 13:2775–1787PubMedCrossRef
17.
go back to reference Sanfey H, Bulkley GB, Cameron JL (1984) The role of oxygen-derived free radicals in the pathogenesis of acute pancreatitis. Ann Surg 200:405–413PubMedCrossRef Sanfey H, Bulkley GB, Cameron JL (1984) The role of oxygen-derived free radicals in the pathogenesis of acute pancreatitis. Ann Surg 200:405–413PubMedCrossRef
18.
go back to reference Esrefoglu M, Gul M, Ateş B, Selimoglu MA (2006) Ultrastructural clues for the protective effect of melatonin against oxidative damage in cerulein-induced pancreatitis. J Pineal Res 40:92–97PubMedCrossRef Esrefoglu M, Gul M, Ateş B, Selimoglu MA (2006) Ultrastructural clues for the protective effect of melatonin against oxidative damage in cerulein-induced pancreatitis. J Pineal Res 40:92–97PubMedCrossRef
19.
go back to reference Dabrowski A, Gabryelewicz A (1992) Oxidative stress. An early phenomenon characteristic of acute pancreatitis. Int J Pancreatol 12:193–199PubMed Dabrowski A, Gabryelewicz A (1992) Oxidative stress. An early phenomenon characteristic of acute pancreatitis. Int J Pancreatol 12:193–199PubMed
20.
go back to reference Folch E, Gelpi E, Rosello-Catafau J, Closa D (1998) Free radicals generated by xanthine oxidase mediate pancreatitis-associated organ failure. Dig Dis Sci 43:2405–2410PubMedCrossRef Folch E, Gelpi E, Rosello-Catafau J, Closa D (1998) Free radicals generated by xanthine oxidase mediate pancreatitis-associated organ failure. Dig Dis Sci 43:2405–2410PubMedCrossRef
21.
go back to reference Du WD, Yuan ZR, Sun J, Tang JX, Cheng AQ, Shen DM, Huang CJ, Song XH, Yu XF, Zheng SB (2003) Therapeutic efficacy of high dose of vitamin C on acute pancreatitis and its potential mechanism. World J Gastroenterol 9:2565–2569PubMed Du WD, Yuan ZR, Sun J, Tang JX, Cheng AQ, Shen DM, Huang CJ, Song XH, Yu XF, Zheng SB (2003) Therapeutic efficacy of high dose of vitamin C on acute pancreatitis and its potential mechanism. World J Gastroenterol 9:2565–2569PubMed
22.
go back to reference Jaworek J (2006) Ghrelin and melatonin in the regulation of pancreatic exocrine secretion and maintaining of integrity. J Physiol Pharmacol 57:83–96PubMed Jaworek J (2006) Ghrelin and melatonin in the regulation of pancreatic exocrine secretion and maintaining of integrity. J Physiol Pharmacol 57:83–96PubMed
23.
go back to reference Jaworek J, Leja-Szpak A, Bonior J, Nawrot K, Tomaszewska R, Stachura J, Sendur R, Pawlik W, Brzozowski T, Konturek SJ (2003) Protective effect of melatonin an its precursor L-tryptophan on acute pancreatitis induced by caerulein over stimulation or ischemia/reperfusion. J Pineal Res 34:40–52PubMedCrossRef Jaworek J, Leja-Szpak A, Bonior J, Nawrot K, Tomaszewska R, Stachura J, Sendur R, Pawlik W, Brzozowski T, Konturek SJ (2003) Protective effect of melatonin an its precursor L-tryptophan on acute pancreatitis induced by caerulein over stimulation or ischemia/reperfusion. J Pineal Res 34:40–52PubMedCrossRef
24.
go back to reference Leon J, Acuna-Castroviejo D, Escames G, Tan DX, Reiter RJ (2005) Melatonin mitigates mitochondrial malfunction. J Pineal Res 38:1–9PubMedCrossRef Leon J, Acuna-Castroviejo D, Escames G, Tan DX, Reiter RJ (2005) Melatonin mitigates mitochondrial malfunction. J Pineal Res 38:1–9PubMedCrossRef
25.
go back to reference Rau B, Bauer A, Wang A, Gansauge F, Weidenbach H, Nevalainen T, Poch B, Beger HG, Nussler AK (2001) Modulation of endogenous nitric oxide synthase in experimental acute pancreatitis: role of anti-ICAM-1 and oxygen free radical scavengers. Ann Surg 233:195–203PubMedCrossRef Rau B, Bauer A, Wang A, Gansauge F, Weidenbach H, Nevalainen T, Poch B, Beger HG, Nussler AK (2001) Modulation of endogenous nitric oxide synthase in experimental acute pancreatitis: role of anti-ICAM-1 and oxygen free radical scavengers. Ann Surg 233:195–203PubMedCrossRef
26.
go back to reference Rodeberg DA, Chaet MS, Bass RC, Arkovitz MS, Garcia VF (1995) Nitric oxide: an overview. Am J Surg 170:292–303PubMedCrossRef Rodeberg DA, Chaet MS, Bass RC, Arkovitz MS, Garcia VF (1995) Nitric oxide: an overview. Am J Surg 170:292–303PubMedCrossRef
27.
go back to reference Konturek SJ, Bilski J, Konturek PK, Cieszkowski M, Pawlik W (1993) Role of endogenous nitric oxide in the control of canine pancreatic secretion and blood flow. Gastroenterology 104:896–902PubMed Konturek SJ, Bilski J, Konturek PK, Cieszkowski M, Pawlik W (1993) Role of endogenous nitric oxide in the control of canine pancreatic secretion and blood flow. Gastroenterology 104:896–902PubMed
28.
go back to reference Inagaki H, Nakao A, Kurokawa T, Nonami T, Harada A, Takagi H (1997) Neutrophil behavior in pancreas and liver and the role of nitric oxide in rat acute pancreatitis. Pancreas 15:304–309PubMedCrossRef Inagaki H, Nakao A, Kurokawa T, Nonami T, Harada A, Takagi H (1997) Neutrophil behavior in pancreas and liver and the role of nitric oxide in rat acute pancreatitis. Pancreas 15:304–309PubMedCrossRef
29.
30.
go back to reference Brown GC, Foxwell N, Moncada S (1998) Transcellular regulation of cell respiration by nitric oxide generated by activated macrophages. FEBS Lett 439:321–324PubMedCrossRef Brown GC, Foxwell N, Moncada S (1998) Transcellular regulation of cell respiration by nitric oxide generated by activated macrophages. FEBS Lett 439:321–324PubMedCrossRef
31.
go back to reference Andrzejewska A, Jurkowska G (1990) Nitric oxide protects the ultrastructure of pancreatic acinar cells in the course of caerulein-induced acute pancretatitis. Int J Exp Path 80:317–324CrossRef Andrzejewska A, Jurkowska G (1990) Nitric oxide protects the ultrastructure of pancreatic acinar cells in the course of caerulein-induced acute pancretatitis. Int J Exp Path 80:317–324CrossRef
32.
go back to reference Werner J, Rivera J, Fernandez-del Castillo C, Lewandrowski K, Adrie C, Rattner DW, Warshaw AL (1997) Differing roles of nitric oxide in the pathogenesis of acute edematous versus necrotizan pancreatitis. Surgery 121:23–30PubMedCrossRef Werner J, Rivera J, Fernandez-del Castillo C, Lewandrowski K, Adrie C, Rattner DW, Warshaw AL (1997) Differing roles of nitric oxide in the pathogenesis of acute edematous versus necrotizan pancreatitis. Surgery 121:23–30PubMedCrossRef
33.
go back to reference Liu X, Nakano I, Yamaguchi H, Ito T, Goto M, Koyanagi S, Kinjoh M, Nawata H (1995) Protective effect of nitric oxide on development of acute pancreatitis in rats. Dig Dis Sci 40:2162–2169PubMedCrossRef Liu X, Nakano I, Yamaguchi H, Ito T, Goto M, Koyanagi S, Kinjoh M, Nawata H (1995) Protective effect of nitric oxide on development of acute pancreatitis in rats. Dig Dis Sci 40:2162–2169PubMedCrossRef
34.
go back to reference Kubes P, Suzuki M, Granger DN (1991) Nitric oxide: an endogenous modulator of leukocyte adhesion. Proc Natl Acad Sci USA 88:4651–4655PubMedCrossRef Kubes P, Suzuki M, Granger DN (1991) Nitric oxide: an endogenous modulator of leukocyte adhesion. Proc Natl Acad Sci USA 88:4651–4655PubMedCrossRef
35.
go back to reference Lomis TJ, Siffring CW, Chalasani S, Ziegler DW, Lentz KE, Stauffer KE, McMillan A, Agarwal N, Lowenstein CJ, Rhoads JE Jr (1995) Nitric synthase inhibitors N-monomethylarginine and aminoguanidine prevent the progressive and severe hypotension associated with a rat model of pancreatitis. Am Surg 6:7–10 Lomis TJ, Siffring CW, Chalasani S, Ziegler DW, Lentz KE, Stauffer KE, McMillan A, Agarwal N, Lowenstein CJ, Rhoads JE Jr (1995) Nitric synthase inhibitors N-monomethylarginine and aminoguanidine prevent the progressive and severe hypotension associated with a rat model of pancreatitis. Am Surg 6:7–10
36.
go back to reference Um SH, Kwon YD, Kim CD, Lee HS, Jeen YT, Chun HJ, Lee SW, Choi JH, Ryu HS, Hyun JH (2003) The role of nitric oxide in experimental caerulein induced pancreatitis. J Korean Med Sci 18:520–526PubMed Um SH, Kwon YD, Kim CD, Lee HS, Jeen YT, Chun HJ, Lee SW, Choi JH, Ryu HS, Hyun JH (2003) The role of nitric oxide in experimental caerulein induced pancreatitis. J Korean Med Sci 18:520–526PubMed
37.
go back to reference Closa D, Hotter G, Prats N, Bulbena O, Rosello-Catafau J, Fernandez-Cruz L, Gelpi E (1994) Prostanoid generation in early stages of acute pancreatitis: a role for nitric oxide. Inflammation 18:469–480PubMedCrossRef Closa D, Hotter G, Prats N, Bulbena O, Rosello-Catafau J, Fernandez-Cruz L, Gelpi E (1994) Prostanoid generation in early stages of acute pancreatitis: a role for nitric oxide. Inflammation 18:469–480PubMedCrossRef
38.
go back to reference Weidenbach H, Lerch MM, Gress TM, Pfaff D, Turi S, Adler G (1995) Vasoactive mediators and the progression from edematous to necrotising experimental acute pancreatitis. Gut 37:434–440PubMedCrossRef Weidenbach H, Lerch MM, Gress TM, Pfaff D, Turi S, Adler G (1995) Vasoactive mediators and the progression from edematous to necrotising experimental acute pancreatitis. Gut 37:434–440PubMedCrossRef
39.
go back to reference Sweiry JH, Mann GE (1996) Role of oxidative stress in the pathogenesis of acute pancreatitis. Scand J Gastroenterol 219:10–15CrossRef Sweiry JH, Mann GE (1996) Role of oxidative stress in the pathogenesis of acute pancreatitis. Scand J Gastroenterol 219:10–15CrossRef
40.
go back to reference Rinderknecht H (1994) Genetic determinants of mortality in acute necrotizing pancreatitis. Int J Pancreatol 16:11–15PubMed Rinderknecht H (1994) Genetic determinants of mortality in acute necrotizing pancreatitis. Int J Pancreatol 16:11–15PubMed
41.
go back to reference Taylor BS, Alarcon LH, Billiar TR (1998) Inducible nitric oxide synthase in the liver: regulation and function. Biochemistry (Mosc) 63:766–781 Taylor BS, Alarcon LH, Billiar TR (1998) Inducible nitric oxide synthase in the liver: regulation and function. Biochemistry (Mosc) 63:766–781
42.
go back to reference Gomez-Cambronero L, Camps B, de La Asuncion JG, Cerda M, Pellin A, Pallardo FV, Calvete J, Sweiry JH, Mann GE, Vina J, Sastre J (2000) Pentoxifylline ameliorates caerulein-induced pancreatitis in rats: role of glutathione and nitric oxide. J Pharmacol Exp Ther 293:670–676PubMed Gomez-Cambronero L, Camps B, de La Asuncion JG, Cerda M, Pellin A, Pallardo FV, Calvete J, Sweiry JH, Mann GE, Vina J, Sastre J (2000) Pentoxifylline ameliorates caerulein-induced pancreatitis in rats: role of glutathione and nitric oxide. J Pharmacol Exp Ther 293:670–676PubMed
43.
go back to reference Gutierrez-Reyes G, Lopez-Ortal P, Sixtos S, Cruz S, Ramirez-Iglesias MT, Gutierrez-Ruiz MC, Sanchez-Avila F, Roldan E, Vargas-Vorackova F, Kershenobich D (2006) Effect of pentoxifylline on levels of proinflammatory cytokines during chronic hepatitis. Scand J Immunol 63:461–467PubMedCrossRef Gutierrez-Reyes G, Lopez-Ortal P, Sixtos S, Cruz S, Ramirez-Iglesias MT, Gutierrez-Ruiz MC, Sanchez-Avila F, Roldan E, Vargas-Vorackova F, Kershenobich D (2006) Effect of pentoxifylline on levels of proinflammatory cytokines during chronic hepatitis. Scand J Immunol 63:461–467PubMedCrossRef
44.
go back to reference Hoebe KH, Gonzalez-Ramon N, Nijmeijer SM, Witkamp RF, van Leengoed LA, van Miert AS, Monshouwer M (2001) Differential effects of pentoxifylline on hepatic inflammatory response in porcine liver cell cultures. Increase in inducible nitric oxide synthase expression. Biochem Pharmacol 61:1137–1144PubMedCrossRef Hoebe KH, Gonzalez-Ramon N, Nijmeijer SM, Witkamp RF, van Leengoed LA, van Miert AS, Monshouwer M (2001) Differential effects of pentoxifylline on hepatic inflammatory response in porcine liver cell cultures. Increase in inducible nitric oxide synthase expression. Biochem Pharmacol 61:1137–1144PubMedCrossRef
45.
go back to reference D’Hellencourt CL, Diaw L, Cornillet P, Guenounou M (1996) Differential regulation of TNF alpha, IL-1 beta, IL-6, IL-8, TNF beta, and IL-10 by pentoxifylline. Int J Immunopharmacol 18:739–748PubMedCrossRef D’Hellencourt CL, Diaw L, Cornillet P, Guenounou M (1996) Differential regulation of TNF alpha, IL-1 beta, IL-6, IL-8, TNF beta, and IL-10 by pentoxifylline. Int J Immunopharmacol 18:739–748PubMedCrossRef
46.
go back to reference Rabinovitch A, Suarez-Pinzon WL (1998) Cytokines and their roles in pancreatic islet beta-cell destruction and insulin-dependent diabetes mellitus. Biochem Pharmacol 55:1139–1149PubMedCrossRef Rabinovitch A, Suarez-Pinzon WL (1998) Cytokines and their roles in pancreatic islet beta-cell destruction and insulin-dependent diabetes mellitus. Biochem Pharmacol 55:1139–1149PubMedCrossRef
47.
go back to reference Malecka-Panas E, Gasiorowska A, Kropiwnicka A, Zlobinska A, Drzewoski J (2002) Endocrine pancreatic function in patients after acute pancreatitis. Hepatogastroenterology 49:1707–1712PubMed Malecka-Panas E, Gasiorowska A, Kropiwnicka A, Zlobinska A, Drzewoski J (2002) Endocrine pancreatic function in patients after acute pancreatitis. Hepatogastroenterology 49:1707–1712PubMed
48.
go back to reference Johansson M, Carlsson PO, Jansson L (2003) Caerulein-induced pancreatitis and islet blood flow in anesthetized rats. J Surg Res 113:13–20PubMedCrossRef Johansson M, Carlsson PO, Jansson L (2003) Caerulein-induced pancreatitis and islet blood flow in anesthetized rats. J Surg Res 113:13–20PubMedCrossRef
Metadata
Title
Comparative Effects of Several Therapatic Agents on Hepatic Damage Induced by Acute Experimental Pancreatitis
Authors
Mukaddes Eşrefoğlu
Mehmet Gül
Fahri Turan
Publication date
01-05-2008
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 5/2008
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-007-0007-y

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