Granulomatous mastitis: clinical, pathological features, and management.

This clinical study was conducted to present clinical, radiologic, and histopathologic features of Granulomatous Mastitis (GM) and evaluate the result of surgical and steroid treatment. Sixteen cases diagnosed histologically as GM were reviewed. Patient characteristics, clinical presentation, radiologic imaging, microbiologic, histopathologic assessment, treatment modalities, recurrence, morbidity, and follow-up data were analyzed. Majority of the patients were child bearing age and all of the patients had a history of breast feeding. Radiologic findings were nonspecific. Histopathology showed the characteristic distribution of granulomatous inflammation in all cases. In 12 cases, surgical excision of the lesion with negative margins was performed. Four cases required quadranectomy because of wideness of the disease. Three patients who had local reoccurrence and three resistant patients were treated by oral prednisone after surgical attempt. Complete remission was obtained and no further recurrence was observed in this patients. GM predominantly occurs in premenopausal women and the clinical symptoms might be misjudged as breast cancer. Histopathologic examination remains the gold standard for the diagnosis. Wide excision of the lesions is the recommended therapy and we suggest steroid therapy in resistant or recurrent disease following the idea that the disease has an autoimmune component.

The effect of cromoglycate on time-dependent histamine and serotonin concentrations in stored blood products.

Biogenic amines, having vascular and inflammatory effects, are accepted as a potential threat for some non-hemolytic transfusion reactions. The aim of this study was to investigate time-dependent histamine/serotonin levels in stored blood products and to see whether cromoglycate has any effect on these mediators. Either for platelet or whole blood, 10-fold concentrations of cromoglycate (1 microg ml(-1), 10 microg ml(-1), 100 microg ml(-1)) with controls prepared as pairs of replicate bags collected from two healthy subjects, separately. By using enzyme immunoassay, histamine and serotonin levels were determined in platelet or blood replicates. Histamine levels increased significantly with time but serotonin remained unchanged during the storage of platelet or blood specimens. Cromoglycate had no effect on these biogenic amines except an increase of serotonin in whole blood specimens containing 100 microg ml(-1) of it. So, cromoglycate cannot protect blood products against rising levels of histamine or serotonin.

Serum levels of intercellular adhesion molecule-1 and nitric oxide in patients with chronic hepatitis related to hepatitis C virus: connection fibrosis.

BACKGROUND/AIMS: Chronicity of inflammation or fibrosis of liver parenchyma in patients with hepatitis C virus infection can be related to features of immunological responses in the liver. Adhesive interactions and free radicals are two important aspects of this inflammatory response. The aim of this study was to investigate serum sICAM-1 and nitric oxide levels in the sera of patients with post-hepatitis C chronic hepatitis. METHODOLOGY: Twenty chronic hepatitis patients diagnosed histopathologically and positive for antihepatitis C virus antibody and 20 healthy carriers of hepatitis C virus were included as study and control groups, respectively. Serum hepatitis C virus-RNA, sICAM-I, nitric oxide, blb, albumin and ALT determinations were made in the specimens of each subject in the study and control group. RESULTS: The mean serum sICAM-I levels of study and control subjects were 463.85 +/- 20.42 ng/mL and 241.85 +/- 13.71 ng/mL, respectively (p < 0.01). The same values for nitric oxide levels were 53.57 +/- 3.63 mumol/L and 32.17 +/- 2.19 mumol/L in the same order and also significantly different from each other (p < 0.01). There was a close correlation between fibrosis scores and serum sICAM-I levels (r = 0.77, p < 0.001), serum albumin (r = -0.54, p = 0.014) and ALT (r = 0.49, p = 0.02). Nitric oxide levels, on the other hand, negatively correlated with fibrosis scores (r = -0.59, p = 0.006), sICAM-1 (r = -0.57, p = 0.009) and ALT (r = -0.54, p = 0.013). CONCLUSIONS: Increased serum levels of sICAM are associated with increased fibrotic changes of patients with hepatitis C virus infection, whereas, nitric oxide which may be a suppressor molecule for fibrosing levels are inversely related to fibrotic process.

The effect of recombinant hepatitis B vaccine therapy in chronic hepatitis B infection.

BACKGROUND/AIMS: Immune-modulator and antiviral treatments for carriers of hepatitis B virus are known to have poor efficacy with a high cost and frequent side effects, which has led to investigation of new treatment modalities. The aim of this study was to determine the efficacy of recombinant hepatitis B vaccine in the treatment of patients with chronic hepatitis B (HBV DNA >5 pg/ml, ALT>60) infection diagnosed histopathologically and asymptomatic carriers (HBV DNA<5 pg/ml, ALT <40, Anti Hbe positive) of the virus. METHODS: The vaccine (Gen Hevac B Pasteur) was administered at baseline and at months one and six to patients with chronic hepatitis and asymptomatic carriers. Ten cases with chronic hepatitis B infection were assigned to a control group to whom no treatment was given. Biochemical and microbiological investigations were performed at baseline and at months three, six and twelve in all cases. Seroconversion of Hbe Ag, loss of HBV DNA and normalization of ALT were considered as a positive response. RESULTS: Patients with chronic hepatitis B who were given the vaccine were found to have significantly low levels of HBV DNA at 12 months (63.2+/-20pg/ml) compared to baseline values (174.4+/-36.9pg/ml), while controls were found to have high levels of HBV DNA at 12 months (223.1+/-33pg/ml) compared to baseline values (165.2+/-33.2pg/ml) (p<0.05). At 12 months, HBV DNA had become negative in seven of 19 patients given the vaccine (36.8%) Four patients with chronic hepatitis (36.35%) were observed to have HBeAg seroconversion and one patient (5.2%) HBsAg seroconversion at the end of 12 months and there were four (21.05%) patients who responded positively to vaccine therapy in this group. Asymptomatic carriers and controls did not have seroconversion of HBs Ag. Also, HBV DNA did not become negative in controls. CONCLUSION: It may be concluded that recombinant hepatitis B vaccine is effective in the treatment of chronic hepatitis B.