Relationship between Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and Thrombosis in Patients with Portal Vein Thrombosis (PVT) without Acquired Risk Factor for Thrombosis.

BACKGROUND: Inflammation occurring after vascular endothelial damage plays a role in thrombus formation. Changes in various blood parameters that develop after the inflammatory condition can be used as a marker to predict thrombus. AIM: This study aimed to investigate the relationship between the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and portal vein thrombosis (PVT). MATERIALS AND METHODS: After applying the exclusion and inclusion criteria to the patients diagnosed with PVT and followed up in our center between January 2006 and May 2018, a total of 38 patients without acquired risk factors for the development of PVT and 52 healthy controls were included in the study. Clinical features and NLR and PLR at diagnosis were evaluated. RESULTS: NLR and PLR values were detected to be significantly higher in patients diagnosed with PVT compared to the control group (P < 0.001 for NLR, P < 0.001 for PLR). Findings were as follows: In acute PVT patients for NLR = 3.645 (area under the receiver operating characteristic (AUROC) 0.886, sensitivity 69.2%, specificity 96.2%, P < 0.001), for PLR = 196.24 (AUROC 0.754, sensitivity 53.2%, specificity 96.2%, P = 0.005), while in chronic PVT patients, for NLR = 3.645 (AUROC 0.744, sensitivity 40%, specificity 96.2%, P = 0.001), and for PLR = 195.93 (AUROC 0.715, sensitivity 44%, specificity 96.2%, P = 0.002). CONCLUSION: NLR and PLR were associated with the diagnosis of PVT. In PVT patients, NLR and PLR values were observed to be significantly higher than the control group. In our study, the relationship between NLR and PLR in patients with noncirrhotic, nonmalignant PVT without acquired risk factors for thrombosis was shown for the first time.

Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit.

BACKGROUND: The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered. OBJECTIVE: Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests. METHODS: Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Mιrioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, ιtagθre, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATB TM Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system,bioMιrieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation. RESULTS: C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients' blood cultures were clonally same strains. PFGE analysis further confirmed this clonality. CONCLUSION: According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.

DNA analysis and DNA ploidy in gastric cancer and gastric precancerous lesions.

Gastric cancer (GCa) is still a common cause of cancer-related deaths worldwide, despite improved diagnostic and therapeutic implications. Hence, early diagnosis has critical importance. Flow cytometry reveals rapid and reproducible quantification of nuclear DNA content of disaggregated tissues and assessment of its significance in various malignant and precancerous lesions. A total of 121 patients with GCa, chronic atrophic gastritis (CAG), gastric polyps, intestinal metaplasia (IM) and gastric dysplasia and 36 healthy controls were enrolled in this study. Flow cytometric measurements of DNA ploidy, total S-phase, G2M-phase and proliferative indexes (PIs) were analysed on fresh gastric biopsy specimens obtained by gastroscopy. DNA aneuploidy was present in 43.75% of the GCas (p < 0.05). We found a DNA aneuploidy rate of 15.38% in CAG, 15.38% in IM and 25% in epithelial dysplasia. One of nine polyps had aneuploidy. None of the normal gastric mucosa samples showed aneuploidy. The controls had lower rates of total S-phase and PIs (p < 0.05). In conclusion, DNA flow cytometry may be offered as an objective diagnostic tool for early detection of malignant transformation in gastric lesions.

A new percutaneous approach for the treatment of hydatid cysts of the liver.

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.

Flow cytometric DNA analysis, and immunohistochemical p53, PCNA and histopathologic study in primary achalasia: preliminary results.

BACKGROUND/AIMS: Primary achalasia is a premalignant disorder of the esophagus. The studies for esophageal cancer pathogenesis may reveal early diagnosis of esophageal cancer. DNA aneuploidy, p53 mutations and cellular proliferation are important factors in cancer development. As far as we know, we have not encountered any study on these factors in achalasia. METHODOLOGY: We studied DNA ploidy by flow cytometry and p53 and PCNA index by immunohistochemical technique and studied histopathology in the esophageal mucosa of primary achalasia and control patients. RESULTS: DNA analysis revealed aneuploidy in 2 of 20 achalasia patients but none of the 18 control patients. Sixty-five percent of achalasia and 22% of normal patients showed p53 positivity (P < 0.05). We have found normal mucosa, basal cell hyperplasia-esophagitis and dysplasia in 13, 22 and 3 patients and p53 positivity in 2, 12 and 3 of these patients, respectively (P < 0.05). PCNA labeling indexes (as % +/- SD) were 34.8 +/- 12.2, and 28.4 +/- 9.3 in achalasia and control groups, respectively (P > 0.05). PCNA labeling index was 28.0 +/- 8.2 in p53(-) and 36.0 +/- 12.9 in p53(+) patients (P < 0.05). PCNA indexes were found 29.3 +/- 9.6 in normal histopathologic group, 31.8 +/- 13.4 in basal cell hyperplasia-esophagitis, and 41.7 +/- 6.5 in dysplasia group (P > 0.05). CONCLUSIONS: DNA aneuploidy, p53 positivity, and higher cellular proliferation index may have important role in the pathogenesis of esophageal cancer in primary achalasia.

Type 2 diabetes locus on 12q15. Further mapping and mutation screening of two candidate genes.

We recently reported evidence of a novel type 2 diabetes locus placed on chromosome 12q15 between markers D12S375 and D12S1684 (Diabetes 48:2246-2251, 1999). Four multigenerational families having logarithm of odds (LOD) scores >1.0 in the original analysis were genotyped for 11 additional markers in this interval to refine this mapping; this allowed us to narrow the linked region to the interval between markers D12S1693 and D12S326. In a multipoint parametric analysis using the VITESSE software, the LOD score for linkage at this location reached 3.1 in one of these families. This interval contains the gene for protein tyrosine phosphatase receptor type R (PTPRR)--a protein that may be involved in both insulin secretion and action. After determining PTPRR exon-intron structure, we identified several polymorphisms in this gene but no mutation segregating with diabetes. The search for mutations was also negative for carboxypeptidase M (CPM)--another candidate gene mapped to this region. In summary, our data provide further evidence for the existence of a type 2 diabetes locus on chromosome 12q15. This locus, however, does not appear to correspond to the PTPRR or CPM, although a contribution of mutations in regulatory regions cannot be excluded at this time.

Mucosal antioxidant defense is not impaired in ulcerative colitis.

BACKGROUND/AIMS: In this study, mucosal antioxidant defense was investigated in the biopsy samples from 12 patients with active ulcerative colitis and from 13 patients under remission. METHODOLOGY: Biopsy samples obtained from healthy colon parts of the same subjects were used as control. RESULTS: No changes were observed between superoxide dismutase, glutathione peroxidase and catalase enzyme activities of control or inflamed biopsy samples. However, antioxidant potential values were found to be higher and malondialdehyde levels lower in inflamed samples compared with controls. CONCLUSIONS: Our results show that in contrast to previous suggestions, mucosal antioxidant defense is not impaired in ulcerative colitis.

Evidence of a novel type 2 diabetes locus 50 cM centromeric to NIDDM2 on chromosome 12q.

To replicate the recent finding of a type 2 diabetes locus (NIDDM2) on 12q, families segregating early-onset autosomal-dominant type 2 diabetes were screened for linkage. Included were 26 Caucasian and 6 non-Caucasian pedigrees with an average age at diabetes diagnosis of 37 +/- 18 years. Affected (n = 233) and nonaffected (n = 152) family members were genotyped for 17 markers covering 90 cM on chromosome 12q. While no evidence for linkage was detected at the NIDDM2 locus, a linkage peak was observed 50 cM centromeric to NIDDM2 at markers D12S375 and D12S1052. In a nonparametric analysis, the Z(all) score was 2.9 (P = 0.015) at D12S375, and increased to 3.8 (P = 0.007) among Caucasian families. Further increase in significance was observed in pedigrees with poor insulin response, with a maximum Z(all) of 6.2 (P = 0.002) at D12S375. Suggestive evidence of linkage was also detected by the parametric analysis, with the heterogeneity logarithm of odds score peaking at 2.5 (alpha = 0.15) between D12S375 and D12S1052. In summary, our data indicate that the NIDDM2 locus does not play a major role in early-onset autosomal-dominant type 2 diabetes. Rather, they strongly suggest that a previously undetected type 2 diabetes locus exists 50 cM from NIDDM2 on 12q.

Tc-99m dextran and Tc-99m HIG findings in patients with ulcerative colitis.

PURPOSE: Various radionuclide methods have been studied for the evaluation of the disease activity and extent of ulcerative colitis and other protein-losing enteropathies. Recently, Tc-99m dextran and Tc-99m human immunoglobulin (HIG) have been used to detect inflammation and protein loss into the intestine, but only a few studies have been reported with these agents. MATERIALS AND METHODS: In this study, Tc-99m dextran and Tc-99m HIG were used to evaluate disease activity and extent in patients with ulcerative colitis. These agents were used in 12 patients with active disease and in five patients in remission, and five healthy control participants also were included. RESULTS: Large bowel activity was detected in 11 of the 12 patients with active ulcerative colitis using Tc-99m dextran and in 10 patients using Tc-99m HIG. Fifty-eight bowel segments were found to be active with endoscopy, 39 with Tc-99m dextran, and 31 with Tc-99m HIG. No intestinal activity was detected in the control participants. Grade 1 activity localization in the large bowel was detected in three patients with ulcerative colitis in remission using Tc-99m dextran and in one patient using Tc-99m HIG. CONCLUSION: Tc-99m dextran is more sensitive for detecting disease activity and extent than is Tc-99m HIG.

Exclusion of insulin receptor substrate 2 (IRS-2) as a major locus for early-onset autosomal dominant type 2 diabetes.

We investigated whether variability at the insulin receptor substrate (IRS)-2 locus plays a role in the etiology of early-onset autosomal dominant type 2 diabetes. By means of radiation hybrid mapping, we placed the human IRS-2 gene on 13q at 8.6 cRays from SHGC-37358. Linkage between diabetes and two polymorphic markers located in this region (D13S285 and D13S1295) was then evaluated in 29 families with early-onset autosomal dominant type 2 diabetes. Included were 220 individuals with diabetes, impaired glucose tolerance, or gestational diabetes (mean age at diabetes diagnosis 36 +/- 17 years) and 146 nondiabetic subjects. Overall, strongly negative logarithm of odds (LOD) scores for linkage with diabetes were obtained by multipoint parametric analysis (LOD score -45.4 at D13S285 and -40.9 at D13S1295). No significant evidence of linkage was obtained under the hypothesis of heterogeneity or by nonparametric methods. Fourteen pedigrees for which linkage could not be excluded (LOD score > -2.0) were screened for mutations in the IRS-2 coding region by dideoxy fingerprinting. However, no mutations segregating with diabetes could be detected in these families. These data indicate that IRS-2 is not a major gene for early-onset autosomal dominant type 2 diabetes, although a role of mutations in the promoter region cannot be excluded at this time.

Short latency inputs to phrenic motoneurones from the sensorimotor cortex in the cat.

Short latency responses were recorded from C5 phrenic roots and intracellularly from phrenic motoneurones following stimulation of the pericruciate cortex or medullary pyramids in cats anaesthetized with Nembutal or chloralose-urethane. Focal stimulation of the cortical surface (single pulses, 0.5-2 ms, 0.3-8 mA) during inspiration evoked EPSPs (latency 4.7 +/- 1.7 ms, rise time 1.9 +/- 1.1 ms, amplitude 0.22 to 3.94 mV) in 42% of motoneurones studied (n = 107). The EPSPs were absent, or on average 60% smaller, following stimulation during expiration. In all but two motoneurones, during both inspiration and expiration, hyperpolarizing potentials were observed either following the initial depolarization or alone. They could be reversed by hyperpolarizing current or chloride injection. Stimulation of the pyramidal tract at mid medullary level (1 to 3 pulses, 0.2 ms) evoked short latency excitation in phrenic motoneurones only with currents of more than 200 microA. Smaller stimuli applied to the medial reticular formation above the pyramidal tract evoked excitation (onset latency 1.5-3.2 ms) in which the earliest part was probably monosynaptic. These results show that the corticospinal responses in phrenic motoneurones are both excitatory and inhibitory. They are not transmitted through the pyramidal tract and are at least disynaptic. Excitation evoked from the medullary pyramidal tract can be explained by current spread beyond the pyramidal tract fibres.