The effect of vitamin D on neurocognitive functions in older vitamin D deficient adults: a pilot longitudinal interventional study.

BACKGROUND: The relationship between vitamin D and cognitive status remains controversial. We aimed to evaluate the effect of vitamin D replacement on cognitive functions in healthy and cognitively intact vitamin D deficient older females. METHODS: This study was designed as a prospective interventional study. A total of 30 female adults aged ≥60 with a serum 25 (OH) vitamin D level of <10 ng/ml were included. Participants were administered 50 000 IU vitamin D3 weekly for 8 weeks followed by a maintenance therapy of 1000 U/day. Detailed neuropsychological assessment was performed prior to vitamin D replacement and repeated at 6 months by the same psychologist. RESULTS: Mean age was 63 ± 6.7 years and baseline vitamin D level was 7.8 ± 2.0 (range: 3.5-10.3) ng/ml. At 6 months, vitamin D level was 32.5 ± 3.4 (32.2-55) ng/ml. The Judgement of Line Orientation Test (P = 0.04), inaccurate word memorizing of the Verbal Memory Processes Test (P = 0.02), perseveration scores of the Verbal Memory Processes Test (P = 0.005), topographical accuracy of the Warrington Recognition Memory Test (P = 0.002), and the spontaneous self-correction of an error in the Boston Naming Test (P = 0.003) scores increased significantly, while the delayed recall score in the Verbal Memory Processes Test (P = 0.03), incorrect naming of words in the Boston Naming Test (P = 0.04), interference time of the Stroop Test (P = 0.05), and spontaneous corrections of the Stroop Test (P = 0.02) scores decreased significantly from baseline. CONCLUSION: Vitamin D replacement has a positive effect on cognitive domains related to visuospatial, executive, and memory processing functions.

Cut-off points for height, weight and body mass index adjusted bioimpedance analysis measurements of muscle mass with use of different threshold definitions.

AIM: Low muscle mass (LMM) is a prerequisite to define sarcopenia. We aimed to report muscle-mass reference cut-off points adjusted for height and weight as muscle-mass threshold best discriminating muscle-weakness and adjusted for body mass index (BMI) significantly lower than that of healthy young population. MATERIAL AND METHOD: We included young adults between 18 and 39 years and community dwelling older adults 60-99 years of age. Bioimpedance analysis (BIA) was used to assess skeletal muscle mass. Skeletal muscle mass index (SMMI) adjusted for height, weight, BMI were calculated [SMMI (height), SMMI (weight), SMMI (BMI)]. Handgrip strength was evaluated with Jamar hydraulic dynamometer for muscle-strength. SMMI (height) and SMMI (weight) cut-offs that predict low muscle-strength were calculated with receiver operator characteristic (ROC) analysis. Low muscle-strength was evaluated by three different thresholds, i.e. 32 kg/22 kg, 30 kg/20 kg, 26 kg/16 kg in males/females. SMMI (BMI) cut-offs were calculated as "mean young SMMI (BMI)-two standard deviation." RESULTS: The young and older reference groups included 301 and 992 individuals, respectively. LMM cut-points for SMMI (height) were (i) 10.8 vs. 8.9 kg/m2 for 32/22 kg; 10.8 vs. 9.4 kg/m2 for 30/20 kg and 11.1 vs. 8.9 kg/m2 for the 26/16 kg thresholds, in males and females, respectively. LMM cut-points for the SMMI (weight) were 40.6% and 33.2% for the all three studied muscle-strength thresholds for males and females, respectively. For all the analyses sensitivity, specificity and likelihood ratios were not sufficiently high in both genders. The SMMI (BMI) cut-points were 1.049 vs. 0.823 kg/BMI for males and females, respectively. CONCLUSIONS: We presented the very first cut-off thresholds for muscle-mass adjusted by height and weight that best discriminate muscle-weakness in the older adults and by BMI that is significantly lower than that of healthy young population. This study suggests that correlation between total skeletal muscle mass measured by BIA (either adjusted for height or weight) and muscle strength is low.

Cut-off points for weight and body mass index adjusted bioimpedance analysis measurements of muscle mass.

AIM: Low skeletal muscle mass (LMM) is a criterion to define both sarcopenia and malnutrition. Muscle mass varies with gender, height, weight or fat mass, and many indices of adjusted-muscle mass have been proposed. We aimed to find reference cut-off points of the skeletal muscle mass index (SMMI) adjusted for weight and body mass index (BMI) in Turkish population. MATERIALS AND METHODS: Adults between 18 and 39 years of age and community-dwelling older adults of 60-99 years of age were included. Body composition was assessed with bioimpedance analysis (BIA). SMMI adjusted for weight and BMI were calculated [SMMI (weight) and SMMI (BMI)]. Muscle strength was assessed by hand-grip-strength with hand dynamometer. SMMI (weight) cut points were calculated from the healthy young adults' data as "mean SMMI-2 standard deviation (SD)". SMMI (BMI) cut points that predict low muscle strength were calculated with ROC analysis. To define low muscle strength, we used three currently suggested low muscle-strength thresholds, i.e., 32 kg/22 kg, 30 kg/20 kg, 26 kg/16 kg in males/females, respectively. RESULTS: 301 healthy young adults (187 male, 114 female) and 992 older people (308 male, 684 female) were included. LMM cut points for SMMI (weight) were 37.4% and 33.6% for males and females, respectively. SMMI (BMI) cut points that best predict the low grip-strength for 32 kg/22 kg; 30 kg/20 kg; 26 kg/16 kg thresholds were1.017 kg/BMI and 0.677 kg/BMI; 1.014 kg/BMI and 0.710 kg/BMI; 1.036 kg/BMI and 0.770 kg/BMI for males and females, respectively. CONCLUSIONS: Muscle-mass adjustment methods and techniques show diversity among the studies and have impact on the LMM cut-off points. This study presents population specific LMM thresholds for skeletal muscle mass adjusted for weight and BMI aiming to increase and improve the general applicability of the leading sarcopenia consensus definitions.

Body mass index and functional status in community dwelling older Turkish males.

Disability is utmost important on an aging population's health. Obesity is associated with increased risk for disability. On-the-other-hand, higher-BMI is reported as associated with better functionality in older people in some reports defined as "obesity paradox". There is some evidence on differential relationship between body weight status and functionality by living setting gender, and different populations. We studied the relation between body mass index and functionality in Turkish community dwelling older males accounting for the most confounding factors: age, multimorbidity, polypharmacy and nutritional status. This is a cross-sectional study in a geriatric outpatient clinic of a university hospital. Functionality was assessed with evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutrition was assessed by mini-nutritional assessment test. Two hundred seventy-four subjects comprised our study cohort. Mean age was 74.4 ± 7.1 years, BMI was 25.8 ± 4.4 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (B = 0.047 and B = 0.128, respectively) (p < 0.05) and better nutritional status (B = 1.94 and B = 3.05, respectively) (p < 0.001) but not with the total number of medications. Higher IADL score was associated with younger age and lower total number of diseases (B = 0.121, B = 0.595, respectively) (p < 0.05) while ADL was not. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling male older people. Our study recommends longitudinal studies with higher participants from different populations, genders and living settings are needed to comment more.

Spirometric obstruction and tobacco exposure among male Turkish nursing home residents.

Spirometric obstruction is a prevalent problem in older adults and related to life-style risk factors. Symptoms related to chronic-obstructive-pulmonary-disease (COPD) are also prevalent symptoms with diverse etiologies - not limited to pulmonary obstruction. Older adults may have unrecognized airway obstruction due to functional limitations or symptoms mis-attributed to age/other co-morbidities. Therefore, spirometric obstruction may clinically be over/under diagnosed. Over last few decades, the burden of smoking-related diseases has increased in older adults. Additional evidence regarding older adults is required. We aimed to study frequency of spirometric obstruction, its over/under diagnosis and tobacco exposure in a group of male nursing-home residents. For spirometric obstruction diagnosis, two different thresholds [(fixed value: 0.70) versus (age-corrected value: 0.65 in residents >65 years of age)] were compared for better clinical practice. One hundred and three residents with 71.4 ± 6.3 years-of-age included. Spirometric obstruction prevalences were 39.8 and 29.1% with fixed and age-corrected FEV1/FVC thresholds, respectively. Age-corrected FEV1/FVC threshold underdiagnosed COPD in 1.9% while fixed threshold overdiagnosed spirometric obstruction in 8.7%. Active smokers were 64.1%, ex-smokers 23.3% and non-smokers 12.6%. Our study suggests high prevalences of spirometric obstruction and smoking in male nursing-home residents in Turkey. We suggest the use of age-corrected FEV1/FVC threshold practicing better than the use of fixed FEV1/FVC threshold in this patient group.

Case report of fatal Mycobacterium tilburgii infection.

There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.

The relationship of body mass index and the functional status of community-dwelling female older people admitting to a geriatric outpatient clinic.

OBJECTIVES: The relationship of body mass index (BMI) with functional status differs in diversified geriatric population and various settings. In this study, we aimed to investigate whether BMI is related to functional status independent of age, nutritional status, multimorbidity, and polypharmacy in a group of Turkish community-dwelling female elderly. DESIGN: This study was conducted using a cross-sectional study design. SETTING: Geriatric outpatient clinic of a university hospital. PARTICIPANTS: There were 438 female patients aged 60 years or older included in the analysis. MEASUREMENTS: Body mass indexes were calculated from weight (kg) divided by the square of height (m). Functional status was assessed with the evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Diseases and drugs were determined after the evaluation of the patients with comprehensive geriatric assessment, physical examination, first-line biochemical tests, and using the patients' self-report and current medication lists. RESULTS: In total, 438 subjects comprised our study cohort. Mean age was 73.3 ± 6.9 years. Mean BMI was 27.8 ± 5.2 kg/m(2). Linear regression analysis revealed significant and independent association of lower BMI with higher ADL and IADL scores (p = 0.02, B = -0.10; p < 0.001, B = -0.17, respectively). ADL and IADL were significantly negatively correlated with BMI in subjects with normal nutrition (p = 0.03, r = -0.122; p = 0.001, r = -0.183) but not in subjects with malnutrition risk or malnutrition. We suggest that lower BMI is associated with better functional status in Turkish community-dwelling female older people. This association is prominent in the subjects with normal nutritional status. CONCLUSIONS: Our study recommends the need for further studies accounting for the nutritional status on the relationship between BMI and functionality in different populations and in different settings. It represents an important example for diversity in BMI-functionality relationship.

Relation between hand grip strength, respiratory muscle strength and spirometric measures in male nursing home residents.

Adverse-outcomes related to sarcopenia are mostly mentioned as physical disability. As the other skeletal muscles, respiratory muscles may also be affected by sarcopenia. Respiratory muscle strength is known to affect pulmonary functions. Therefore, we aimed to investigate the relations between extremity muscle strength, respiratory muscle strengths and spirometric measures in a group of male nursing home residents. Among a total of 104 male residents, residents with obstructive measures were excluded and final study population was composed of 62 residents. Mean age was 70.5 ± 6.7 years, body mass index: 27.7 ± 5.3 kg/m2 and dominant hand grip strength: 29.7 ± 6.5 kg. Hand grip strength was positively correlated with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) (r = 0.35, p < 0.01 and r = 0.26, p < 0.05, respectively). In regression analysis, the only factor related to MIP was hand grip strength; among spirometric measures only parameter significantly related to grip strength was peak cough flow (PCF). The association of PCF with grip strength disappeared when MIP alone or "MIP and MEP" were included in the regression analysis. In the latter case, PCF was significantly associated only with MIP. We found peripheric muscle strength be associated with MIP and PCF but not with MEP or any other spirometric parameters. The relation between peripheral muscle strength and PCF was mediated by MIP. Our findings suggest that sarcopenia may affect inspiratory muscle strength earlier or more than the expiratory muscle strength. Sarcopenia may cause decrease in PCF in the elderly, which may stand for some common adverse respiratory complications.

Uncomplicated diabetes does not accelerate age-related sarcopenia.

BACKGROUND: Diabetes is reported to accelerate sarcopenia (age-related loss of muscle mass and function). We aimed to assess muscle mass and strength in elderly diabetics, elderly non-diabetics, younger diabetics and healthy subjects, and to define correlates of muscle mass and strength in these subjects. METHODS: Sixteen elderly diabetics, 16 younger diabetics, 16 elderly non-diabetics and 18 younger non-diabetics were included. Elderly and diabetic subjects were first evaluated with exercise testing. Isokinetic leg extension and flexion tests were performed using a Cybex 350 dynamometer. Muscle mass was calculated using bioelectric impedance analysis. RESULTS: Muscle mass was similar between all groups; however, muscle strength was significantly lower in diabetic and non-diabetic elderly subjects compared with younger diabetic subjects and non-diabetics. Muscle strength was positively correlated with albumin, metabolic equivalent and hemoglobin, and inversely correlated with age, HbA1c, functional capacity and CRP. Independent correlates of muscle strength were age and hemoglobin. There was no clinically significant correlate of muscle mass. Presence or duration of diabetes was not associated with muscle mass or strength. CONCLUSIONS: Uncomplicated diabetes does not seem to accelerate aging-related muscle mass or strength loss. Exercise test parameters may be useful markers in the screening of sarcopenia.

Is inferior vena caval filter an alternative treatment option for geriatric patients that cannot use anticoagulation therapy?

The incidence of deep vein thrombosis (DVT) and pulmonary embolism has been increasing in the elderly because of hypercoagulability associated with aging. Age has also been identified as an independent risk factor for bleeding complications related to anticoagulation therapy. Inferior vena cava filters could be used as alternatives to anticoagulant therapy for the prevention of pulmonary embolism when anticoagulation is either contraindicated or ineffective. Here, we report two geriatric patients who had documented acute DVT and in whom inferior vena caval filter was used because of the patients have a contraindication to use an anticoagulation.

Limited utility of adipokine levels in the diagnosis of malnutrition in the elderly.

BACKGROUND AND AIMS: Adipokine levels may have a role in the diagnostic and prognostic evaluation of malnutrition. The aim of the present study was to evaluate the correlation between malnutrition score and leptin, other biological markers, and body mass index (BMI) in the diagnosis of malnutrition in the elderly. METHODS: In this cross-sectional observational study, we enrolled subjects over 70 years. Exclusion criteria were diabetes mellitus, obvious thyroid disorders, significant edema, renal dysfunction, chronic liver disease, symptomatic cardiovascular diseases, and malignity. Patients' demographic and medical data were recorded and anthropometric measurements were performed. Laboratory parameters including leptin, IGF-1, IGFBP-3, IL-6, TNF-α were measured. We defined malnutrition according to mini nutritional assessment (MNA) scale. Patients were divided into four groups according to BMI quartiles. RESULTS: Average age of the patients was 81.9 ± 4.8 years, 68.2 % female and 31.8 % male. According to their MNA scores, 103 (66.9 %) were well nourished, 33 (21.4 %) were under malnutrition risk and 18 (11.7 %) were malnourished. MNA total and screening scores were positively correlated with albumin, BMI, high-density lipoprotein cholesterol and estimated glomerular filtration rate. Serum leptin levels (ng/ml) were 18.9 ± 22.6, 22.3 ± 21.9, 51.9 ± 85.5, and 61.7 ± 56.1 in BMI groups 1-4, respectively. BMI was positively correlated with leptin and triglyceride levels. Leptin levels were similar among nutritional state groups. Neither BMI nor MNA scores had any significant correlation with adiponectin, ghrelin, IGF-1, or IGFBP-3. CONCLUSIONS: Adipokine levels do not seem to give relevant information in nutritional state assessment.

Corticosteroid treatment normalizes QTc prolongation and improves heart block in an elderly patient with anti-Ro-positive systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystemic disease which potentially involves various organs including the skin, joints, kidneys, liver, hematopoetic system, and serous membranes. It is rarely seen in elderly males. The most common cardiovascular involvement type is pericarditis. Anti-Ro antibodies may be associated with neonatal lupus which causes heart blocks. Recent literature indicates that anti-Ro antibodies may be associated with various rhythm and conduction disturbances in the adulthood. The most common finding associated with anti-Ro antibodies is prolonged corrected QT (QTc) interval. Herein, we present an elderly male patient with anti-Ro-positive SLE associated with prolonged QTc interval and AV blocks that significantly improved after corticosteroid treatment.

Comorbidities, polypharmacy, functionality and nutritional status in Turkish community-dwelling female elderly.

BACKGROUND AND AIMS: Most elderly persons live in developing countries where current geriatric epidemiological data are scarce. We aimed to study major comorbidities, polypharmacy, functional and nutritional status in a Turkish community-dwelling female elderly clinic population. METHODS: Female geriatrics outpatient clinic patients were assessed cross-sectionally. Patients underwent comprehensive geriatric cassessment, including identification of chronic diseases, drugs, functionality, and nutrition. Comorbidities and drugs were defined by the review of patients' self-reports and current medications. Geriatric depression and cognition were assessed by 30-item geriatric depression scale and Folstein mini-mental-state-examination. Functional status was assessed by the evaluation of activities of daily living (ADL) and instrumental activities of daily living (IADL) scales. Nutritional assessment was performed by mini-nutritional-assessment-short form. RESULTS: Five-hundred and fifteen patients were included in this study over an 8-year period. Mean age was 73.4 ± 6.9 years. Mean number of chronic diseases was 2.8. 61.1 % had >3 chronic diseases. Most common 3 diagnoses were hypertension (75.3 %), depression (45.5 %) and dementia (39.4 %). Mean number of drugs was 4.8. Polypharmacy was noted as 63.2 and 47.6 % by definitions as >4 or >5 chronic drug use, respectively. Subjects with at least one dependency of ADL and IADL were 23.4 and 64.0 %. Prevalence of poor nutrition was 39.1 %. In patients with at least one ADL or IADL dependency, undernutrition (p < 0.001), dementia (p < 0.001), cerebrovascular accident, Parkinson's disease, diabetes were more prevalent (p < 0.05) and were taking higher number of drugs (p < 0.01). CONCLUSIONS: Polypharmacy and functional dependency seem to be prevalent among female elders in our country. Nutritional status was worse than the other reported urban area of Turkey and also than among males of same region but better than among Iranian counterparts. This study illustrates geographical differences in and between the individual countries and supports the continued need for comprehensive geriatric assessment worldwide.

Assessments of functional status, comorbidities, polypharmacy, nutritional status and sarcopenia in Turkish community-dwelling male elderly.

Functionality, comorbidities, polypharmacy, nutritional status and sarcopenia affect the prognosis of elderly excessively. These parameters are influenced by the population, living settings and age. We aimed to study these parameters in Turkish community-dwelling male elderly. We studied 274 male elderly ≥60 years of age admitted to our Geriatrics outpatient clinics. Mean age was 74.4 ± 7.1 years; 47.4% of the subjects were ≥75 years, 24.1% were ≥80 years. Mean activities-of-daily-living (ADL) and instrumental ADL (IADL) scores were 9.4 and 11.1, respectively. Patients with at least one-dependence at ADL-IADL were 22.6%-47.2%, and more than half-dependence at ADL-IADL were 2.8%-17.9%, respectively. Mean number of comorbidities were 2.6. Most common diagnosis was hypertension with 65%; mean number of drugs were 4.5; 55.3% were using ≥4 chronic drugs. Prevalences of malnutrition were 3.7%-6.9%, malnutrition risk were 23.5%-26.7% by the mini nutritional assessment test-long form and short form, respectively. Calf circumference was measured <31 cm in 10.5%. Our findings suggest that Turkish community-dwelling male elderly may have greater prevalences of functional dependence, sarcopenia but lower rates of malnutrition and similar rates of polypharmacy compared with the western developing countries and developed countries. This study emphasized the geographical differences in and/or between the individual countries highlighting the need for studies both country- and world-wide.

Cytomegalovirus esophagitis precipitated with immunosuppression in elderly giant cell arteritis patients.

Cytomegalovirus (CMV) infection is generally associated with significant immunosuppression. Cellular immunity is particularly important and corticosteroid treatment increases the risk of CMV infection substantially. Immunocompetence generally decreases with age, older patients are at higher risk for developing CMV disease than are younger patients. CMV infection in the immunocompetent adults is quite rare. Esophagitis is the second most common gastrointestinal manifestation of CMV infection after colitis. Herein, we present three cases of giant cell arteritis who developed CMV esophagitis after various periods of corticosteroid treatment. CMV infection should be included in the differential diagnosis of GI disease in immunocompromised patients, and the clinician should pursue appropriate diagnostic and therapeutic interventions aggressively.

Olanzapine as a cause of peripheric edema in an elderly man.

Edema can be observed as side-effect of many medications, of which calcium channel blockers are the best known. Elderly people use many more medications than their younger counterparts and are usually more prone to developing medication-induced side-effects. Atypical antipsychotics have occasionally been shown to induce peripheric edema. Age is put forward as a risk factor for olanzapine-induced edema. We present here the case of an elderly man who developed upper- and lower-limb edema during use of olanzapine to emphasize its relatively frequent association with edema in the elderly.

Prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey.

The prevalence of sarcopenia differs between different populations, ages, gender and between settings such as the community and nursing homes. Studies on the association of sarcopenia with functional status revealed conflicting results whereas its association with nutritional status is well documented. We aimed at investigating the prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey. Fat free mass (FFM) was detected by bioelectric impedance analysis. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental activities of daily living (IADL). Nutritional assessment was performed by Mini Nutritional Assessment Test (MNA(R)). One hundred fifty-seven male residents composed the study cohort. Mean age was 73.1 +/- 6.7 years. The prevalence of sarcopenia was 85.4%. No significant correlation was found between sarcopenia and ADL or IADL. There was a weak but significant correlation between IADL score and FFM (r = 0.18; p = 0.02). Sarcopenic residents had lower MNA score than non-sarcopenic residents (18.1 +/- 3.2 vs. 21.8 +/- 0.8, p = 0.02). FFM was significantly lower in the residents with malnutrition compared to well-nourished residents (26.8 +/- 1 kg/body surface area vs. 28.1 +/- 1.8 kg/body surface area, p < 0.05). In conclusion, the prevalence of sarcopenia was very high among male nursing home residents in Turkey. Sarcopenia was associated with low nutritional status but not with functional status.

The Role of the Local Bone Marrow Renin-Angiotensin System in Multiple Myeloma

Objective: Angiotensin II promotes growth and angiogenesis via type 1 receptors (AGTR1) in certain tumors. In this study, we examine the bone marrow AGTR1 expression in multiple myeloma (MM) and its relationship with the regulation of angiogenesis and prognostic factors. Materials and Methods: Bone marrow AGTR1 mRNA levels of 39 MM patients and 15 healthy controls were analyzed with quantitative RT-PCR. Immunohistochemical staining of the tissue vascular endothelial growth factor (VEGF), CD34, and factor VIIIrAg (fVIIIrAg) was used to assess bone marrow angiogenesis. Results: Bone marrow samples of the patients showed increased VEGF, fVIIIrAg, and CD34 staining and higher AGTR1 expression levels when compared to controls. Patients with severe-diffuse bone marrow infiltration showed higher bone marrow VEGF, fVIIIrAg, CD34, and AGTR1 mRNA levels when compared to other patients. Conclusion: AGTR1 expression was found positively correlated with plasma ß2-microglobulin level and patients with increased AGTR1 expression showed increased bone marrow CD34 levels.

Thrombotic thrombocytopenic purpura associated with multiple myeloma.

Thrombotic thrombocytopenic purpura is a thrombotic microangiopathic disease. Associations with collagen vascular diseases, pregnancy, some drugs, surgical intervention, and infections are documented (known). Malignancy is also one of the known factors associated with thrombotic thrombocytopenic purpura. These malignancies are usually the disseminated solid organ tumors. Hematological malignancies constitute a rare association. Here, we present a patient with thrombotic thrombocytopenic purpura associated with multiple myeloma and discuss the pathogenesis. To our knowledge, this is the first case report of thrombotic thrombocytopenic purpura associated with multiple myeloma.

Primary biliary cirrhosis and IgG-kappa type multiple myeloma both respond well to vincristine, adriamycin and dexamethasone: is there a pathogenic relationship?

Patients with primary biliary cirrhosis (PBC) are at increased risk for various malignancies including lymphoproliferative diseases. In this report, we describe a 52-year-old man with the simultaneous diagnosis of PBC and IgG-kappa multiple myeloma (MM). Serum cholestatic enzyme (alkaline phosphatase and gamma-glutamyltransferase) levels decreased after three courses of vincristine, adriamycin and dexamethasone treatment followed by six courses of melphalan and methylprednisolone, given for MM. Pruritus also disappeared. He did not show any progression during the next 24 months of clinical follow-up. The coexistence of PBC and MM is rare and the pathogenetic mechanism under this association remains unclear. Clinical improvement of both diseases in this patient after chemotherapy may indicate an association; however, absence of concurrency in previous large series increases the possibility of coincidence in this case. When compared with the previous single case reports, this case provided long-term results about response after chemotherapy.