The Radioprotective Effects of Caffeic Acid Phenethyl Ester and Thymoquinone on Oxidative and Nitrosative Stress in Liver Tissue of Rats Exposed to Total Head Irradiation.

OBJECTIVE: The aim of this study is to investigate the effects of addition of caffeic acid phenethyl ester (CAPE) and thymoquinone (TQ) on oxidative and nitrosative stress in the liver tissue of irradiated rats. METHODS: Forty Sprague-Dawley rats were divided into five groups to test the radioprotective effectiveness of TQ and CAPE administered by intraperitoneal injection. Appropriate control groups were also studied. RESULTS: Liver antioxidant capacity, as measured by levels of total superoxide scavenger activity (TSSA), non-enzymatic superoxide scavenger activity (NSSA) and glutathione-S-transferase (GST) activity except superoxide dismutase (SOD) activity, were statistically lower in the irradiation (IR) group compared to all other groups. Total superoxide scavenger activity and NSSA were statistically higher in the IR plus TQ and IR plus CAPE groups compared to all other groups. In contrast, glutathione peroxidase (GSH-Px) activity was significantly found to increase in the IR plus CAPE group compared to control groups. The xanthine oxidase (XO), nitric oxide synthase (NOS) activities, nitric oxide (NO●) and malondialdehyde (MDA) levels in the IR group were statistically higher than in the other groups. Moreover, XO activity in the IR plus TQ group was statistically lower than all other groups including the IR plus CAPE group. In addition, NO● level was found to increase in all groups when compared to the normal control group. CONCLUSIONS: Thymoquinone and CAPE decrease oxidative and nitrosative stress markers and have antioxidant effects, which also increase antioxidant capacity in the liver tissue of irradiated rats.

Effects of acute pancreatitis on plasma total and lipid bound sialic Acid levels: an experimental study in rats.

BACKGROUND: We investigated the relationship between serum levels of total sialic acid, lipid bound sialic acid and acute pancreatitis in a rat model of a common bile duct ligation induced acute pancreatitis. METHODS: Twenty five Sprague-Dawley male rats weighing 250-300 g were divided into two groups (n=10: control, n=15: experimental). In the control group only a sham laparotomy was performed. In the experimental group, acute pancreatitis was induced by common pancreatobiliary tract ligation. After 36 hours the rats were killed and amylase, serum total sialic acid, lipid bound sialic acid and lipid profiles were measured. Histopathological confirmation of acute pancreatitis was done using hematoxylin and eosin staining. RESULTS: Mean amylase, total sialic acid (TSA) and lipid bound sialic acid (LBSA) measurements in the experimental group were significantly higher than in the control group. There was no significant difference in the lipid profiles between the two groups. CONCLUSION: Increased levels of TSA and LBSA can be useful as specific markers in the diagnosis of acute pancreatitis independent of serum lipid profile.

Awareness of allergy patients about herbal remedies: a cross-sectional study of residents of Ankara, Turkey.

OBJECTIVE: The use of herbs in patients with allergic diseases is a special problem and still controversial. The objective of this questionnaire-based study was to determine the rate of herbal use in allergy clinic outpatients as well as to explore patient knowledge. METHODS: Patients with respiratory and/or skin disease, either atopic or non-atopic were assigned to a prospective questionnaire study conducted in allergy clinic outpatients. RESULTS: Three hundred and ninety-five patients enrolled in the study. The mean age was 33.50+/-12.14 years. Participants generally had a high educational level (40.5% college and 39% university graduated). The rate of herbal use was 14.2%. All characteristics were similar within herbal user and non-user patients, except gender and age. The number of female patients who use herbal products was greater than for males (p=0.043). Herbal use was common in patients in their late thirties (p=0.024). Three main rationales for herbal use were revealed: (i) acting upon advice of someone (41.1%); (ii) the belief that "herbals are always more beneficial than chemicals" (37.5%); and (iii) the trust that "herbals are always safe" (21.4%). Most of the participants have "no idea" (41.5%) or are "not sure" (33.7%) about potential harmful effects of herbs to allergic people. CONCLUSION: People will continue to use herbals for one reason or another. Allergists and clinical immunologists need to become more knowledgeable about herbal therapies so that they can inform patients about either the benefits or possible harmful effects of herbs.

Effects of intranasal mometasone furoate on blood pressure in patients with allergic rhinitis.

BACKGROUND: Nasal congestion as the main symptom in patients with allergic rhinitis can impair nasal breathing. It causes hypoxia and concomitant sympathetic system activation, which may also lead to increased blood pressure levels in these patients. OBJECTIVE: We postulated that appropriate therapy, including intranasal steroids, decreases blood pressure levels in patients with allergic rhinitis. METHODS: In our study, we investigated the effect of intranasal steroid (4 weeks of mometasone furoate) on blood pressure changes in 45 patients with allergic rhinitis whose main complaint was nasal congestion. We used ambulatory monitoring for determining blood pressure levels before and after intranasal steroid therapy. None of the patients had any other systemic diseases. RESULTS: We found a significant decrease of daytime systolic and diastolic blood pressures and mean blood pressure values (daytime systolic blood pressure: 120 vs. 117 mmHg, p = 0.024; daytime diastolic blood pressure: 73 vs. 71 mmHg, p = 0.027; daytime mean blood pressure: 86 vs. 83 mmHg, p = 0.007). Although insignificant, we also found lower night-time systolic and mean blood pressure values (nighttime systolic blood pressure: 109 vs. 107 mmHg, p = 0.182; nighttime mean blood pressure 77 vs. 73 mmHg, p = 0.116). CONCLUSIONS: We found that post-treatment daytime average systolic, diastolic, and mean arterial blood pressure levels were significantly lower compared to values obtained during exacerbation of allergic rhinitis. Decrease in blood pressure with treatment of allergic rhinitis and nasal congestion suggests that nasal congestion and impaired nasal respiration may affect blood pressure and potentially cause serious problems in hypertensive patients with allergic rhinitis.

Recurrent urticaria lesions in a heparin-allergic patient: most likely another form of "recall urticaria".

In this report we describe a female patient with a history of heparin allergy and recurrent urticaria lesions at definite locations where the heparin injections were administered previously.

Not all food additive related reactions originate from commercial foods: chronic urticaria due to home-made canned tomato.

Additives and preservatives in commercial foods have been implicated in the etiology of chronic urticaria, but such foods have not been widely accepted. In some countries, as in ours, people prefer to use home-made foodstuffs to avoid potentially hazardous commercial additives. However, not all home-made foodstuffs are safe, especially regarding allergies. In this report, we describe a patient with chronic urticaria due to home-made canned tomato prepared using "tomato drug" as a "safe (!)" additive.

Reduced antioxidant defense capacity in myocardial tissue from guinea pigs treated with 5-fluorouracil.

Antioxidant defense capacity was investigated in myocardial tissue from guinea pigs treated with 5-fluorouracil (5-FU) at a dose of 400 mg/kg/d daily for 5 d administered intraperitonally. Treatment with 5-FU lowered the activities of cardiac superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) accompanied by higher catalase (CAT) activity. Further, antioxidant potential (AOP) values were lower but oxidation resistance (OR) and malondialdehyde (MDA) levels were higher in the 5-FU-treated tissue. With regard to myocardial iron (Fe) and copper (Cu) levels, no significant differences were found between the groups. Results suggest that 5-FU treatment causes impairment in the myocardial antioxidant defense system and leads to cardiac peroxidation. It has been postulated that these changes might be responsible for the 5-FU cardiotoxicity seen in some patients, and antioxidant therapy might provide a therapeutic advantage.

Late recall urticaria.

In the cases reported of recall urticaria, the clinical manifestations usually develop within an hour. We present the clinical case of an 11-year-old boy who, after 9 weeks of immunotherapy with pollen extracts (Phleum pratense and Festuca elatior), presented an urticarial lesion 48 to 72 h after of the injection on the opposite arm to where it had been applied and in the same place where the previous injections had been administered. This reaction continued for every injection given during the time that the immunotherapy was applied twice a week, and for the 6 weeks that it was applied once a week. Subsequently, the urticarial lesions appeared every two or three injections.

Skin test positivity to aeroallergens in the patients with chronic urticaria without allergic respiratory disease.

The etiology of chronic urticaria and angioedema remains uncertain in most of the patients. There are several agents and factors including medications, foods and food additives, infections, contactants, inhalants, physical factors and autoimmunity that implicated in provoking urticaria symptoms. In addition, the possible role of house dust mites has been considered in a few reports. We investigated skin test positivity to house dust mites and other inhalants in 259 patients with chronic idiopathic urticaria and angioedema but without allergic rhinitis and/or asthma. Results were compared with both 300 healthy controls and 300 atopic patients. Immediate cutaneous reactivity to one or more allergens was detected in 71 patients in the study group (27.4%). The most common allergens were house dust mites (24.7%). Skin prick test sensitivity to other inhalant allergens including pollens, molds and cockroach were 7.7%, 0.4% and 0.8%, respectively. In the healthy control group 7% of patients were found as atopic with respect to skin prick test results. The most common allergens in healthy controls were pollens (6%), and house dust mites (4.7%). In atopic control group, pollens and mites are also the most common allergens detected in skin prick test (62% and 50.3%, respectively). The difference between study and healthy control group was statistically significant with respect to presence of atopy and mite sensitivity (p < 0.001). Similar differences were not established in other inhalant allergens. Significant mite sensitivity in the study group is not a coincidence. Because, ratio of skin test positivity to house dust mites in the study group was higher than the healthy controls, but was not as high as atopic patients. Furthermore, the rate of skin reactivity to other aeroallergens was not different from healthy controls. Urticaria as a sole clinical manifestation in mite sensitive patients was unusual.

Systemic reactions due to allergen immunotherapy.

The purpose of this study was to evaluate the incidence, type and potential risk factors of systemic reactions due to conventional allergen immunotherapy with aqueous extracts. The study was carried out retrospectively and included 1,506 patients to whom allergy injections had been given during the last 12 years. Symptoms in each reaction were classified with respect to time of onset, involvement of respiratory tract or skin, and presence of hypotension. The results showed 125 systemic reactions in 109 patients (1 per 1,831 injections), of which 52.8% were of the skin, 12% were respiratory symptoms, 30.4% respiratory symptoms and skin, 0.8% hypertension only, and 4% hypotension with respiratory symptoms and skin reactions. Most of the systemic reactions (84.8%) occurred within the 30 min after injection. Forty-one per cent of the systemic reactions were observed in the build-up period (1/52 patients, 1/1, 158 injections) and 58.4% in the maintenance injection period (1/73 patients, 1/2,311 injections). Seventy-six systemic reactions were related to pollen season (60.8%), 11 were related to injection from a new vial (8.8%) and eight to both pollen season and a new vial (6.4%). Thirty-five per cent of the patients who experienced systemic reactions had bronchial asthma, but there was no correlation between frequency of the two. There was also no correlation between systemic reactions and age or sex. It was concluded that immunotherapy has a low rate of systemic reactions and that maintenance immunotherapy appears to be associated with fewer such reactions than the build-up period. The 30 min waiting period is adequate for conventional immunotherapy. However, a longer waiting period may be necessary for high-risk subjects.

The allergen spectrum in Turkey and the relationships between allergens and age, sex, birth month, birthplace, blood groups and family history of atopy.

This study was performed retrospectively on 2,342 patients who were treated in the allergy department from 1985 to 1996. All patients had been skin prick tested with 40 common aeroallergens in Turkey. Allergen immunotherapy was given to 1,455 of them. Mean age of the patients was 25.9 (range 5 to 69). Fifty-five percent were males and 45.1% females. Forty percent had bronchial asthma and 60.2% had allergic rhinitis. Fifty-five percent of them had a family history of atopy. Sensitization to pollens was 59.7%, to house dust 20.5%, to molds 2%, to pollens and molds 2.9%, to pollens and house dust 11.5%, to molds and house dust 1.4%, and to pollens, molds and house dust 2%. The grass pollen sensitivity was threefold more common than that for trees, and fourfold more common than that for weed pollens. The diagnosis of bronchial asthma in the 5 to 9 age group was higher than in the other age groups (p < 0.005). The mold sensitization increased in parallel with age and it was the highest in 60 to 69 age group (p < 0.0001). There was no relationship between the allergens and sex, history of family atopy or blood group (p > 0.05) (except for house dust allergen). However, there was a relationship between month of birth (p < 0.005, p < 0.05, respectively) and birthplace (p < 0.001) with pollen and house dust allergen. House dust and molds were more common causes of bronchial asthma than pollens (p < 0.001, p < 0.01, respectively). In conclusion, the most common allergen was pollen in Turkey. In addition, atopic diseases are multifactorial, including such factors as genes and environment. Month and place of birth may influence early exposure and subsequent risk for allergy.

Impact of Helicobacter pylori and Giardia lamblia infections on chronic urticaria.

The etiology of chronic urticaria is largely unknown. The role of Helicobacter pylori infection, which is the most important cause of gastritis and peptic ulcer, is not clear in the pathophysiology of chronic urticaria. In this study, we aimed to define the impact of H. pylori on chronic urticaria. Thirty-eight patients who had chronic urticaria of unknown origin and dyspepsia were included in the study. In all patients, standard laboratory tests for detection of urticaria etiology were performed. Mean urticaria symptom scores of patients were carried out. All patients underwent upper gastrointestinal endoscopy. The presence of H. pylori was investigated using urease testing and histopathology. Duodenal fluid aspirated during upper endoscopy was examined for the presence of Giardia lamblia. H. pylori infection was detected in 29 patients. After successful eradication of H. pylori infection, the mean symptom score of patients did not change significantly (2.6 +/- 0.6 vs., 2.4 +/- 0.8). Only one patient had a total disappearance of urticaria symptoms. Out of 38 patients, only one had G. lamblia infection. The results of our study suggest that there is no association between H. pylori infection and chronic urticaria.

Dermographism and atopy in patients with Behçet's disease.

Dermographism is the appearance of whealing and erythema within minutes in a site where skin has been exposed to pressure or mechanical irritation. In our clinical observations, dermographism seems to be frequent in patients with Behçet's disease. Since the prevalence of allergic responses is reportedly increased in vasculitic syndromes, we aimed to assess dermographism and atopy in a group of Behçet's patients. The study group comprised 30 consecutive patients with Behçet's disease. The study was carried out in two parts: elicited dermographism and atopy tests. In the first part, dermographism was investigated in the study group (Behçet's patients) and 230 healthy controls. In the second part, the study group, 30 healthy controls and 17 patients with allergic bronchial asthma were evaluated for specific and nonspecific atopy. Dermographism was found to be increased in patients with Behçet's disease. Peripheral blood eosinophil count, serum total IgE and nasal eosinophil scores were similar in patients with Behçet's disease and healthy controls. Although blood eosinophil count and serum total IgE levels were higher in allergic bronchial asthma patients than in Behçet's patients, the difference was significant only in the former. Skin prick test was positive in three of the patients with Behçet's disease and in six healthy controls. The difference was statistically insignificant (p > 0.05). None of the Behçet's disease patients had pathergy or a pathergy-like reaction at the site of the skin prick test after 48 h. In conclusion, our results confirm the general impression that dermographism is common in patients suffering from Behçet's disease.

Effects of allergen immunotherapy on the nasal mucosa in patients with allergic rhinitis.

Despite the varied immunological changes occurring after allergen immunotherapy, the precise mechanism, or the mechanisms responsible for clinical effectiveness of allergen immunotherapy have not been clearly determined. Postulated immunomodulatory mechanisms include a decrease in cellular responsiveness, a production of blocking antibodies, a reduction in the number of mast cells, and activation of T-cell suppressor mechanisms. Nineteen allergic rhinitis patients (study group) with house dust mite sensitivity and 10 nonallergic control subjects were studied. In the study group, the nasal mucosal biopsies were obtained prior to immunotherapy and were repeated after 1 year, and specimens were evaluated by light and electron microscopy. After the third month of immunotherapy, nasal symptom scores were reduced significantly and disappeared in the sixth month (p <0.01). No significant changes were observed in the levels of immunoglobulins, IgG subclasses and complement levels (p <0.05), except IgG4/IgG1 ratio (p <0.05). A comparison of histopathological findings of nasal mucosa in each case revealed an improvement in epithelial loss, inflammation, thickening of basal membrane and fibrosis (p <0.05). A significant correlation was observed between epithelial loss and mast cell accumulation with symptom score (p <0.001). These results suggest that the improvement of nasal epithelial cells and reduction of mast cell accumulation in nasal mucosa may be one of the mechanisms that could explain the improvement of nasal allergy symptoms following immunotherapy.

Levothyroxine versus ketotifen in the treatment of patients with chronic urticaria and thyroid autoimmunity.

BACKGROUND: Thyroid hormone replacement therapy has previously been discussed as a feasible therapeutic approach in patients with chronic urticaria and/or angio-oedema (CUA) and thyroid autoimmunity (TA). OBJECTIVE: The efficacy of levothyroxine was investigated in patients with CUA and TA by comparing it with ketotifen treatment. METHODS: A total of 60 patients with CUA and TA were included in the study. Patients were divided into two groups, which were matched with respect to sex, age and symptom score. Each group consisted of 30 patients. Patients in one group were treated with ketotifen and the other with levothyroxine. After completion of the treatment periods, the pre- and post-treatment symptom scores, onset time of drug effects, duration of symptom-free period, recurrence ratios, recurrence times and side effects were evaluated for each drug. The two drugs were compared with each other according to these parameters. RESULTS: Ketotifen treatment provided significant relief of symptoms. However, these beneficial effects were observed only in ongoing treatment. Symptoms reappeared in all patients during the drug-free follow-up period. On the other hand, 18 of 30 patients were completely improved and three patients partially improved with levothyroxine treatment. Symptoms did not recur in the completely improved patients. CONCLUSION: Levothyroxine is an important and inexpensive treatment alternative in patients with CUA and TA.

Primary non-Hodgkin's lymphoma of the liver (case report).

Primary non-Hodgkin's lymphoma of the liver is very uncommon, and fewer than 100 cases have been reported in the literature. Most reports describe either solitary or multiple mass lesions in the liver. A diffuse lesion without nodule formation is a relatively rare form of the disease. The histologic feature of the disease is a predominantly large cell lymphoma of B-cell lineage. We report a case of primary B-cell non-Hodgkin's lymphoma which had diffusely infiltrated the liver without nodule formation.

Aspirin impairs antioxidant system and causes peroxidation in human erythrocytes and guinea pig myocardial tissue.

This study aims to investigate possible effects of aspirin treatment on cellular oxidant/antioxidant system. In the first part of the study, 15 guinea pigs were given aspirin at three different doses (2200, 440 and 10 mg/kg/day) for 30 days and five were fed on the same diet without aspirin. After a month, animals were killed and their hearts were removed for use in analyses. In the other part, after fasting blood samples were obtained from 11 volunteer subjects, they were given aspirin (approximately 10 mg/kg/day) for 30 days and second blood samples were obtained after 1 month. Five volunteer subjects also participated as placebo control. Oxidant/antioxidant parameters, namely superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT), malondialdehyde (MDA), nonenzymatic superoxide scavenger activity (NSSA), susceptibility to oxidation (SO) and antioxidant potential (AOP) values, were assayed in the samples. Antioxidant system was found to be impaired in the heart tissue from guinea pigs and in the erythrocytes from volunteer subjects. AOP and NSSA values were lower and MDA higher after aspirin treatment in both heart tissues and erythrocytes. In guinea pig heart tissue, SO was lower, but GSH-Px and CAT were unchanged after aspirin treatment. In human erythrocytes, SO was unchanged, but GSH-Px and CAT activities were increased after aspirin treatment. Changes in guinea pig heart tissues from animals treated with higher aspirin doses were more drastic relative to those of human erythrocytes, but no meaningful differences were observed between analysis parameters of control and lower-dose (10 mg/kg/day) aspirin-treated animals. Our results suggest that high-dose aspirin exerts significant toxicity to guinea pig myocardium and normal dose aspirin may cause peroxidation in the human erythrocytes due to its oxidant potential. We suppose that antioxidant supplementation may be beneficial for the people using aspirin for longer periods in order to prevent peroxidation damages.

Renin angiotensin aldosterone system and drug allergies complicated with hypotension.

It has been discussed in several studies that non-immunologic factors, such as renin angiotensin aldosterone system (RAAS) may play a role in the pathophysiology of anaphylaxis. This study aimed to determine whether RAAS plays a part in the fall in blood pressure during drug reactions or not. Twenty patients who experienced hypotension during drug reaction and 15 healthy volunteers were enrolled in this study. None of the patients in the study or control groups were under treatment with any drug that was capable of influencing to RAAS. Serum levels of angiotensin-I (A-I), angiotensin-II (A-II), angiotensin converting enzyme (ACE) and aldosterone were measured in both study and control groups. The Mann-Whitney U test was used to compare the results of the groups. There were no statistically significant differences between the groups with respect to A-I, A-II, ACE and aldosterone levels. It was concluded that a fall in blood pressure during drug reaction must be the result of mast cell mediator effects on the vascular wall rather than RAAS impairment.

Primary composite tumour with bipartite differentiation of the esophagus.

Primary small cell carcinoma of the esophagus is a rare tumour. A primary composite tumour of the esophagus is even rarer and only four cases had been reported in the literature up to August 1998. The definitive histogenesis of this tumour remains controversial in spite of the additional information provided by electron microscopy and immunohistochemistry. In the presented case, histologically, the tumour tissue was composed of two malignant components: approximately 50% of a moderately differentiated squamous cell carcinoma, and approximately 50% of a small cell carcinoma. A lot of morphological transition zones were observed between the squamous cell carcinoma components and the small cell carcinoma components in some areas in the squamous cell carcinoma component. Histochemically and immunohistochemically, the small cell carcinoma cells demonstrated argyrophil granules, and Cytokeratin and Chromogranin A reactivity, but the squamous cell carcinoma cells demonstrated only Cytokeratin reactivity. Negative reactivity for argentaffin granules, neuron-specific enolase and S-100 were observed in both the small cell carcinoma and the squamous cell carcinoma components. Histological, histochemical and immunohistochemical findings suggest that a primary composite tumour of the esophagus may be derived from a totipotent primitive cell in the basal region of the squamous mucosa of the esophagus. The patient received chemotherapy preoperatively but died one month after the initial diagnosis.

A questionaire study evaluating the knowledge and approach by physicians about arterial blood gas.

BACKGROUND AND AIMS: Arterial blood pressure analysis is a frequently applied method in the diagnosis and follow-up of respiratory insufficiency and in the treatment of patients under risk. It is very important to take and analyze the blood gas sample properly. Therefore, a questionary study was performed which evaluated the knowledge and the approach of doctors working in various specialties. MATERIALS AND METHODS: A questionary form consisting of 27 questions were filled by 100 specialist physicians who participated in the study. RESULTS: It was observed that doctors participating in our study had partly sufficient knowledge regarding administration and evaluation of arterial blood gas. It was considered that in intensive care unit experience of participant doctors during their intern periods was a very important factor. But it was observed that most of the participant specialist physicians performed Allen test before radial artery puncture, and they frequently preferred femoral artery for their first puncture option, and they did not pay attention in the proper transportation of the samples and in sending cultures from arterial cannula against risk of infection. The majority of doctors who participated in our study stated that they would like to receive training in arterial blood gas administration and evaluation. DISCUSSION: In conclusion, to take samples from arterial blood gas is an invasive operation and if not performed correctly it can cause complications to develop. Transportation and evaluation is as much important as sampling. It is very important to provide sufficient education to candidates of specialist physicians and to organize training courses aimed to increase their knowledge and experience during the period of their speciality without taking their speciality into account.