Erythrocyte zinc level in patients with atopic dermatitis and its relation to SCORAD index.

INTRODUCTION: Atopic dermatitis (AD) is a chronic, pruritic inflammatory disease, characterized by a relapsing-remitting course. The pathogenesis of atopic dermatitis is not completely understood, although the disorder appears to result from the complex interaction between immune abnormalities, genetic and environmental factors. Trace elements are essential for normal functioning of the immune system. AIM: To determine zinc levels in serum and erythrocytes of patients with AD using an atomic absorption spectrometric technique and to investigate the relationship between those levels and disease activity. MATERIAL AND METHODS: Sixty-seven patients and 49 controls were enrolled into the study. The disease severity of AD patients was determined according to the Scoring Atopic Dermatitis (SCORAD) index. We measured zinc levels in serum and erythrocytes by the atomic absorption spectrophotometric technique. RESULTS: Erythrocyte zinc levels were significantly lower in AD patients than in the control group (p < 0.001), whereas serum zinc levels did not differ between the groups (p = 0.148). In the AD patient group there was a negative correlation between the SCORAD score and erythrocyte zinc levels (r = -0.791; p < 0.001). CONCLUSIONS: The negative relationship between disease severity and erythrocyte zinc levels might suggest an immunopathological link between AD progression and intracellular zinc metabolism.

Cardiac metastasis of hepatocellular carcinoma in a young non-cirrhotic patient, to the left ventricle.

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver.(1,2) The most common extrahepatic metastatic sites are lung, abdominal lymph nodes and bone, while its cardiac metastasis is rare.(2,3) Metastasis of HCC into the cardiac cavity is mostly caused by direct tumor invasion of vena cava inferior with continuous extension into the right cardiac cavity.(4,5) Right heart metastasis without invasion of inferior vena cava, which may be caused by hematogenous spread of cancer cells, is rarely reported.(6,7) This paper announces an unusual case of isolated involvement of left ventricle (LV) together with myocardial invasion of HCC. Our patient is known to be the first case with isolated HCC metastasis to the left ventricle. Strikingly, the patient was young and non-cirrhotic with negative serum HBsAg, and anti-HCV results.

The influence of specific factors on postoperative morbidity in young adults with bronchiectasis.

BACKGROUND: Surgical treatment of bronchiectasis is associated with acceptable mortality and morbidity rates. To date, few reports on the prediction of postoperative morbidity using some preoperative measures have been presented. We present our results regarding the influence of some specific factors on postoperative morbidity on young adult patients who were treated surgically for bronchiectasis. METHODS: Between January 2000 and July 2007, 122 patients were operated upon. Female gender, increased number of resected segments, presence of haemoptysis and bilateral disease, compromised pulmonary function test (FEV1/VC<60%) and absence of preoperative fiberoptic bronchoscopy (FOB) were examined as the potential risk factors for postoperative complications such as persistent air leak (PAL), atelectasis, residual air space (RAS), bronchopleural fistula (BPF) and empyaema. RESULTS: There was no operative mortality. Morbidity was observed in a total of 16 patients with an overall morbidity rate of 13.1%. Complete resection was achieved in 88 patients (72.1%). The number of resected segments was not found to be significantly associated with increased morbidity. Presence of preoperative haemoptysis did not correlate with postoperative complications significantly. Absence of preoperative FOB was not found to be associated with post-operative complications (p<0.05). Compromised PFT was significantly associated with RAS (p=0.028), however it was not associated with increased risk of PAL, atelectasis or empyaema significantly. CONCLUSION: Multi-segmental resectable bronchiectasis should not be considered an occult risk factor for morbidity after resection. Associated non-severe haemoptysis and absence of preoperative bronchoscopy are not associated with significant increased risk of postoperative morbidity.

Risk factors for oral allergy syndrome in patients with seasonal allergic rhinitis.

BACKGROUND: Oral allergy syndrome (OAS) is a unique allergic reaction to food, which is caused by cross-reactivity between proteins in fresh fruits or vegetables and pollens. Predisposing factors for OAS are not well known in patients with seasonal allergic rhinitis. OBJECTIVE: Identify the probable risk factors for OAS in patients with seasonal allergic rhinitis. STUDY DESIGN: One hundred and eleven consecutive patients with seasonal allergic rhinitis were included. Patients were evaluated in terms of symptom scores and skin prick test positivity scores. Prick-by-prick tests with the fresh fruit or vegetable were carried out in patients who describe oral allergy syndrome. Patients with OAS and without OAS were compared statistically. RESULTS: OAS was more frequent in females than males (p=0.01). Odds ratio for gender (male/female) was 3.80 (95% confidence interval: 1.28-11.32). Within nasal symptoms, only nasal itching was related with OAS (P<0.05). The logistic regression analysis revealed a significant association between the prevalence of the OAS and age, asthma, TSS and TSTP (p<0.05). CONCLUSION: Not all patients with seasonal allergic rhinitis develop OAS. It is likely that, patients with OAS have some additional risk factors other than atopy.

Mammalian Meat Allergy Accompanied by Venom Allergy: A Review of 12 Cases.

There has recently been an increase in mammalian meat allergy (MMA) in the Black Sea Region of Turkey. It has been associated with the expansion of tick populations.Tick bites appear to result in sensitization to the carbohydrate allergen galactose-alpha-1, 3-galactose, which is present in many types of mammalian meats. In this study, we have emphasized that  Ixodes ricinus named tick type which is implicated in meat allergy, is found in domestic animals of Black Sea Region of Turkey. A new concept has been recently raized; suggesting that having an alpha-gal allergy is associated with an increased risk of sensitization to multiple venom spesific immunoglobulin (Ig) E. Our aim is to evaluate the clinical characteristics of adult patients with MMA and its relationship with insect sting reactions in Turkey. Patients referring to the allergy outpatient clinic with possible MMA were interviewed regarding reactions to a stinging insect. Demographic features and detailed histories of the patients were recorded. Skin prick test (SPT) with commercial beef extract and venom allergens, as well as prick to prick tests with raw beef and cooked beef were performed. Serum total IgE and beef meat specific IgE were measured. Of 50 interviewed patients, 12 patients (4 male [33,3%] and 8 female [66,6%]) had a history of venom hypersensitivity reaction. The mean age was 36.50±13.35 years (range:18-61). History of other allergic diseases was present in 8 (66.6%) patients. Both venom and meat allergy were confirmed with SPT or prick to prick tests in these 12 patients. Among these patients sensitization to honey bee venom was more frequent (83%). MMA and venom allergy are influenced by the same environmental exposures. We believe that there may be shared immunologic factors and similar antigens; making venom allergic patients more susceptible to MMA.

The significance of histopathologic patterns in positive tuberculin skin test site.

BACKGROUND: The histologic features of tuberculin skin test site is not uniform. It may be related to status of tuberculosis. METHODS: Forty-eight purified protein derivative (PPD) positive-cases were chosen for the study. Thirty of the subjects had active tuberculosis. As previously reported, the histologic pattern of inflammatory reaction seen in the test site classified into three type: (a) Perivascular (PV)-type, (b) Basal spongiotic dermatitis (BSD)-type and (c) Erythema multiforme (EM)-type. The frequencies of histological patterns in active tuberculosis and latent tuberculosis were statistically analyzed. RESULTS: In active tuberculosis group including 30 patient, 17 (56.7%) EM-type, 9 (30%) BSD-type and 4(13.3%) PV-type inflammation were seen. Among 18 latent tuberculosis, there were 2 (11.1%) EM-type, 7 (38 8%) BSD-type and 9 (50%) PV-type inflammatory reactions. The EM-type inflammation was more common in active tuberculosis group. Bulla formation was seen in seven subjects with active tuberculosis. CONCLUSION: The histological pattern of PPD reaction site may be an important sign reflecting the nature of the tuberculosis, which may be either latent or active. The bulla formation is an important sign for active pulmonary tuberculosis. Further, detailed immunohistopathologic studies of PPD reaction with large number of cases may give important clues about tuberculosis immunology.

MRI findings of intracranial tuberculomas.

PURPOSE: Tuberculosis involvement of the central nervous system continues to represent a serious problem, particularly in developing countries. The aim of this study was to characterize the magnetic resonance imaging (MRI) findings of intracranial tuberculoma, a form of neurotuberculosis. METHODS: We retrospectively reviewed the data of 27 patients with intracranial tuberculomas. These consisted of 17 women and 10 men with a mean age of 26 years (14-51). MRI was performed on all patients. RESULTS: A total of 64 tuberculomas were found in these patients, of which 41 were distributed in the cerebral hemispheres, 17 in the cerebellar hemispheres, and 6 in the brainstem. Accompanied meningitis was detected in three patients, hydrocephalus in five patients, and hydrocephalus with meningitis in one patient. CONCLUSION: MRI makes a significant contribution to diagnosis of intracranial tuberculomas and can objectively determine accompanying abnormalities.

Spirometric changes after pleural decortication in young adults.

BACKGROUND: The collection of pleural fluid and thickened pleura restrict the movement and expansion of lung. The main treatment strategy is lung decortication for the thickened pleura. The aim of this study was to investigate lung functions before and after pleural decortication in young adults. METHODS: A total of 63 patients with thickened pleura were retrospectively evaluated. Before the operation, patients with tuberculosis (n = 36) were treated with anti-tuberculosis therapy for 3-6 months. Patients with non-tuberculosis causes (n = 27) had been treated with broad-spectrum antibiotics. Forced expiratory volume in 1 s (FEV1, %), forced vital capacity (%) and vital capacity (litre) were measured before and after decortication. RESULTS: Spirometric parameters FEV1 (68.1 +/- 16.7 vs 71.01 +/- 14.4), forced vital capacity (67.6 +/- 16.4 vs 71.3 +/- 14.4) and vital capacity (2.6 +/- 0.6 vs 2.8 +/- 0.7) significantly improved after the operation (P +/- 0.01). Spirometric changes were not significantly different between tuberculosis and non-tuberculosis groups. CONCLUSION: Pleural decortication may improve the lung restoration in patients with thickened pleura and also improve lung functions significantly in young adults.

The effectiveness of splenic autotransplantation: an experimental study.

BACKGROUND: The purpose of this study was to establish the effects of spleen autotransplantation on immunity and to examine the viability of autotransplanted spleen tissue. METHODS: Three groups were assigned and following operations were performed in twenty New Zealand rabbits. 1st group: sham laparotomy, 2nd group: splenectomy and 3rd group: splenectomy and splenic autotransplantation. Scintigraphic methods, hematological-immunological tests and histopathological examination were used to evaluate the effects of splenic autotransplantation. RESULTS: Histopathological findings showed that eight rabbits had splenic regrowth and two had necrosis of autotransplanted splenic tissue. Preoperative hematological and immunological findings compared with those at sixth week postoperatively. In group 3, postoperative immunoglobulin G, immunoglobulin M and interleukin-1 levels were significantly increased when compared with preoperative levels. Between all groups, postoperative leukocyte counts were found to be significantly higher in group 2 comparing with group 1. In group 2, postoperative platelet counts were significantly higher in comparison to group 1 and 3. No statistically significant difference was detected between the groups for immunoglobulin G, immunoglobulin M and interleukin-1 levels. CONCLUSION: Conservative treatment is important in patients with splenic injury. However when splenectomy is indicated, splenic autotransplantation into the omentum pouch could be a reliable method for reconstruction of splenic functions and the viability of the implanted spleen tissue can be monitored by scintigraphy and laboratory examination.

Physicians' preference for controller medication in mild persistent asthma.

BACKGROUND: Although the asthma guidelines recommend inhaled corticosteroids(ICS) or leukotriene receptor antagonists-(LTRAs) for the treatment of mild persistent asthma, factors governing the physicians' preference are unknown. We aimed to investigate the preference of physicians for the controller medication and the factors governing their choice. METHODS: A self-administered questionnaire composed of 16 questions that aimed to determine the preference of the physicians for the first choice controller medication in mild persistent asthma and physician and patient related factors that may be associated with this selection was e-mailed to the members of the Turkish National Society of Allergy and Clinical Immunology and distributed to participants in the 21st congress. RESULTS: Of the 670 questionnaires, there were 51% participants and 336 of them were complete enough to be included in the analysis. Low dose ICS was preferred as the first choice controller medication for mild persistent asthma by 84.5% of the physicians. The reasons for physicians' preference were different for ICS and LTRA. In the logistic regression analysis, use of asthma guidelines (OR:3.5, 95%CI:1.3-9.3, p = 0.01), alignment in guidelines (OR:2.9, 95%CI:1.4-5.8, p = 0.002) and the opinion that it is a more effective (OR:2.3, 95%CI:1.1-4.8, p = 0.02) were independently associated with ICS preference. Being a pediatrician (OR:5.4, 95%CI: 2.7-10.5, p < 0.001) and the opinion that it has better patient compliance (OR:4.4, 95%CI: 1.6-12.0, p = 0.004) were independently associated with LTRA preference. CONCLUSION: Surveyed Turkish physicians, the majority of whom were specialists, preferred ICS over LTRA as controller medication in mild persistent asthma. Asthma guidelines, training background (pediatrician versus not) and perceived efficacy and patient compliance appeared to influence their preferences.

TERT Expression in Pituitary Adenomas.

OBJECTIVE: Although pituitary adenomas have benign histomorphological features, some of them may present in an aggressive manner. To predict the behaviour of these tumours, telomerase reverse transcriptase (TERT) activity in pituitary adenomas has been the subject of a few studies with contradictory results. This study aims to investigate whether immunohistochemical expression of TERT differs in neoplastic and nonneoplastic pituitary tissues and aims to investigate whether TERT expression is related to clinicopathological features of pituitary adenomas. MATERIAL AND METHOD: The study included 48 patients who had been diagnosed with pituitary adenomas and had clinical follow-ups. Nonneoplastic pituitary tissues were obtained from autopsy specimens (n=20). Immunohistochemistry for TERT antibody was performed. Both the nuclear and cytoplasmic expression of TERT antibody was noted, and total combined TERT staining was evaluated according to nuclear and cytoplasmic stainings. RESULTS: TERT expression did not differ between neoplastic and nonneoplastic pituitary tissues. Neither total (combined nuclear and cytoplasmic) TERT nor nuclear TERT expression revealed any statistically significant relationship with any of the clinicopathological features. Higher cytoplasmic TERT expression was observed in adenomas with recurrence than adenomas without recurrence (p=0.035). CONCLUSION: This study introduces the notion that immunohistochemical expression of TERT does not differ in neoplastic and nonneoplastic pituitary tissues. Pituitary adenomas with cytoplasmic immunohistochemical expression of TERT have significantly higher rates of recurrence. Further studies, including combined methods of immunohistochemistry and molecular analyses in larger groups, may reveal applicable results for the clinical significance of TERT in pituitary adenomas.

Anaphylactic reactions presenting with hypertension.

BACKGROUND: Although a few case reports about hypertensive anaphylaxis (HA) are available in the present literature, there is no study about the prevalence of HA. In this study, we review our cases with anaphylaxis presenting with hypertension and ascertain its prevalence. The documents of the patients who had anaphylactic reactions after the procedures performed for the diagnosis and treatment of allergic diseases in GATA Haydarpasa Clinic of Allergy and Immunology between January 2010 and December 2014 were retrospectively reviewed. Within the study period, 324 patients had undergone 4332 procedures in which 62 of them had developed anaphylaxis. RESULTS: During the procedures, the rate of anaphylaxis was found to be 1.43 %. The rate of HA among the anaphylaxis patients was 12.9 % (8 of 62 patients). During treatments, 2 patients received adrenaline injections without any adverse reaction. CONCLUSIONS: HA may be seen at a considerable rate during an anaphylactic reaction. Anaphylaxis and hypertension can be recovered by adrenaline injection when required. According to the best of our knowledge, this study is the first original study about the prevalence of HA in English-language medical literature.

Toxocara Canis IgG Seropositivity in Patients with Chronic Urticaria.

We aimed to investigate IgG antibody levels specific to Toxocara canis (T. canis), a parasite which subsists in dog's intestine, on serum samples obtained from patients with chronic urticaria (CU) to evaluate effective risk in CU etiopathogenesis. In this study, 73 patients diagnosed with CU and 109 healthy individuals as control group, were included. Various factors such as sex, age, education and income, daily hand washing habits, history of dog owning and soil eating were questioned in patient anamnesis. T. canis IgG antibodies were detected using an enzyme linked immunosorbent assay (ELISA) kit prepared with T. canis larval excretory-secretory antigens. Positive results were confirmed with western blot (WB) WB test. We found T. canis IgG positivity in 17.8% (n=13) of patients (n=73) with CU. But we did not observe any T. canis IgG positivity in healthy controls (n=109). Low molecular weight bands (24-35 kDa) were observed in 11 samples in WB analyses while two of the samples were weakly positive. It is revealed that dog owning history increases T. canis seropositivity 12.9 times while insufficient daily hand washing habit (less than six times a day) increases seropositivity 20.7 times. Our study showed that T. canis may trigger CU since we found 17.8% seropositivity in 73 patients with CU and none in 109 healthy individuals. Moreover, various socio-demographic characteristics have been shown to affect T. canis seropositivity in patients with CU.

Values of high-resolution computed tomography and pulmonary function tests in managements of patients with chronic hepatitis C virus infection.

AIM: To investigate pulmonary involvement via pulmonary function tests (PFT) and high-resolution computed tomography (HRCT) in patients with chronic hepatitis C virus (HCV) infection. METHODS: Thirty-four patients with chronic HCV infection without diagnosis of any pulmonary diseases and 10 healthy cases were enrolled in the study. PFT and HRCT were performed in all cases. RESULTS: A decrease lower than 80% of the predicted value was detected in vital capacity in 9/34 patients, in forced expiratory volume in one second in 8/34 patients, and in forced expiratory flow 25-75 in 15/34 patients, respectively. Carbon monoxide diffusing capacity (DLCO) was decreased in 26/34 patients. Findings of interstitial pulmonary involvement were detected in the HRCT of 16/34 patients. Significant difference was found between controls and patients with HCV infection in findings of HRCT (chi2=4.7, P=0.003). Knodell histological activity index (KHAI) of 28/34 patients in whom liver biopsy was applied was 9.0+/-4.7. HRCT findings, PFT values and DLCO were not affected by KHAI in patients with HCV infection. In these patients, all the parameters were related with age. CONCLUSION: We suggest that chronic hepatitis C virus infection may cause pulmonary interstitial involvement without evident respiratory symptoms.

Esomeprazole: a safe alternative to lansoprazole allergy?

Proton pump inhibitors (PPIs) are widely prescribed drugs in daily practice. Allergic reactions, even small number of anaphylactic reactions to PPIs have been reported. Omeprazole, lansoprazole, pantoprazole, rapeprazol and esomeprazole are classified in the same group. Despite the similarity of biochemical structures among these drugs, presence of cross-reactivity between PPIs is controversial.1,2 In this letter, we present 3 lansoprazole allergy cases, who were prescribed and took esomeprazole safely after allergic reactions to lansoprazole.

Histopathological and immune alterations in autopsied kidneys.

OBJECTIVES: To collect data on all detectable histologic and immune alterations from the kidneys of 55 autopsy cases. METHODS: This prospective study was carried out at the Department of Pathology, Medical Faculty, Trakya University, Edirne, Turkey. Fifty-five cases were subjected to the study among 248 autopsies that were performed in 2011 and 2012. All kidney samples were evaluated under a light microscope and fresh tissue samples were used for immunofluorescence microscopy. Immunohistochemically kappa (κ) and lambda (λ) antibodies were applied to the tissue sections. The glomerular, tubulo-interstitial, and vascular alterations, as well as immune depositions were noted. RESULTS: The microscopic morphology was close to normal histology in only 23 cases, and 23 cases had glomerular alterations. Nineteen cases had at least one immune deposition. There was immunoglobulin A deposition in 13 cases, and 9 cases showed positivity for both κ and λ immunohistochemically, and there was no clonal positivity. CONCLUSION: The most striking outcome of our study is the high rate of immune depositions. There was also a significant number of glomerular and non-glomerular renal alterations. 

Progesterone skin test in severe attacks of angioedema during menstrual cycle.

Progesterone hypersensitivity (PH) is a rare clinical condition that displays hypersensitivity to endogenous or exogenous progesterone. It is characterized by cyclic dermatologic manifestations at the end of the luteal phase that disappear some days after menses. We present a case of 24-year-old woman showing severe angioedema attacks occurring from the first day of her menstruation and continuing for 4-5 days and having positive progesterone intradermal test (IDT). To our knowledge, there is no case in the literature which is coupled with PH isolated angioedema attacks. In this case report we will discuss diagnostic value of progesterone IDT.

Congenital Pulmonary Airway Malformation Type 2: A Case Report with Review of the Literature.

A congenital pulmonary airway malformation is a rare disorder of the pulmonary airway and a hamartomatous mass of disorganized lung tissues with various degrees of cystic change. A 20-year-old pregnant woman who did not have previous clinical follow-up during her pregnancy visited the gynecology department for her first check on the 19th week of gestation. The sonogram, showed severe hydrops fetalis. Laboratory findings were consistent with non-immune hydrops fetalis. Medical abortion was performed and the fetus was sent to our department for a complete fetal autopsy. Macroscopically, whole parts of the fetus had striking oedema. Massive pleural and peritoneal effusions were seen on dissection. The left lung filled the whole thoracic cavity. The heart was displaced to the right and the right lung was compressed. Microscopically, the left lung mass showed dilated bronchiole-like structures (1-20 mm) that were lined with ciliated columnar cells without any intervening mucinous cells. The subepithelial stroma contained thin, interrupted smooth muscle fibers and elastic connective tissue without cartilage plates. Our case is a very good example of non-immune hydrops fetalis associated with congenital pulmonary airway malformation type 2. Prenatal clinical and ultrasonographic follow-ups during pregnancy are very important for early diagnosis of congenital malformations.