Natural History of Congenital Generalized Lipodystrophy: A Nationwide Study From Turkey.

CONTEXT: Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disorder characterized by near-total lack of body fat. OBJECTIVE: We aimed to study natural history and disease burden of various subtypes of CGL. DESIGN: We attempted to ascertain nearly all patients with CGL in Turkey. SETTING: This was a nationwide study. PATIENTS OR OTHER PARTICIPANTS: Participants included 33 patients (22 families) with CGL and 30 healthy controls. MAIN OUTCOME MEASURE(S): We wanted to ascertain genotypes by sequencing of the known genes. Whole-body magnetic resonance imaging was used to investigate the extent of fat loss. Metabolic abnormalities and end-organ complications were measured on prospective follow-up. RESULTS: Analysis of the AGPAT2 gene revealed four previously reported and four novel mutations (CGL1; c.144C>A, c.667_705delinsCTGCG, c.268delC, and c.316+1G>T). Analysis of the BSCL2 gene revealed four different homozygous and one compound heterozygous possible disease-causing mutations (CGL2), including four novel mutations (c.280C>T, c.631delG, c.62A>T, and c.465-468delGACT). Two homozygous PTRF mutations (c.481-482insGTGA and c.259C>T) were identified (CGL4). Patients with CGL1 had preservation of adipose tissue in the palms, soles, scalp, and orbital region, and had relatively lower serum adiponectin levels as compared to CGL2 patients. CGL4 patients had myopathy and other distinct clinical features. All patients developed various metabolic abnormalities associated with insulin resistance. Hepatic involvement was more severe in CGL2. End-organ complications were observed at young ages. Two patients died at age 62 years from cardiovascular events. CONCLUSIONS: CGL patients from Turkey had both previously reported and novel mutations of the AGPAT2, BSCL2, and PTRF genes. Our study highlights the early onset of severe metabolic abnormalities and increased risk of end-organ complications in patients with CGL.

Marine-Lenhart syndrome with papillary thyroid carcinoma.

Graves' disease with accompanying functioning nodules is known as Marine-Lenhart syndrome. Autonomously functioning thyroid nodules (AFTNs) also within Graves' thyroid tissue are almost always bening in nature. A 45-year-old man developed hyperthyroidism due to the coexistence of Graves' disease and AFTN. Total thyroidectomy was performed. The hyperfunctioning nodule with centrally hypoactive foci detected by technetium-99m thyroid scanning was histologically diagnosed as papillary thyroid carcinoma that was 2.5 cm in diameter. We report the presence of papillary thyroid carcinoma within AFTN in patients with Marine-Lenhart syndrome, which has not been reported so far.

Nuclear morphometric and morphological analysis of exfoliated buccal and tongue dorsum cells in type-1 diabetic patients.

BACKGROUND: Diabetes mellitus type 1 that results from immunologically mediated damage to the ß-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells. AIM: The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients. MATERIALS AND METHODS: We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica™). RESULTS: The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006). CONCLUSION: The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.

Extensive investigation of 114 patients with Sheehan's syndrome: a continuing disorder.

OBJECTIVE: Sheehan's syndrome (SS) is a well-known cause of hypopituitarism resulting from postpartum pituitary necrosis. Because of its rarity in Western society, its diagnosis is often overlooked. We aimed to investigate the clinical, laboratory, and radiological aspects of SS in a large number of patients. STUDY DESIGN: A retrospective assessment of the medical records of 114 patients with SS was conducted. In addition, sella turcica volumes of 29 healthy women were compared with those of patients by magnetic resonance imaging examinations. RESULTS: The mean period of diagnostic delay was 19.7 years in patients with SS. It was found that 52.6% of patients had nonspecific complaints, 30.7% had complaints related to adrenal insufficiency, and 9.6% had complaints related to hypogonadism when diagnosed. At the time of diagnosis, 55.3% of the patients had panhypopituitarism, while 44.7% had partial hypopituitarism. The number of deficient hormones was found to be increased over the years. None of the patients whose basal prolactin was below 4.0 ng/ml had adequate prolactin responses to TRH test, while all patients whose basal prolactin was above 7.8 ng/ml had adequate responses. Mean sella volume was found to be significantly lower in the SS group (340.5±214 mm(3)) than that in the healthy group (602.5±192 mm(3)). CONCLUSIONS: SS is a common cause of hypopituitarism in underdeveloped and developing countries. The main reasons for diagnostic delay seem to be the high frequency of patients with nonspecific complaints and neglect of SS. In addition, the TRH stimulation test was found to have a high sensitivity and specificity to recognize PRL deficiency. Furthermore, small sella size may have an important contributing role in the etiopathogenesis of SS.

Visual field defects in 23 acromegalic patients.

Pituitary tumors are the third most common primary intracranial neoplasm. Pathologic proliferation of the somatotrophs results as overproduction of growth hormone presenting as acromegaly. In pituitary adenomas typical visual field (VF) defect is bitemporal hemianopsia but tumor size and optic chiasmal position may cause variable VF defects and VF examination may remain normal. We retrospectively reviewed the medical records of 23 acromegalic patients with pituitary adenomas who received VF tests in the Department of Ophthalmology and Endocrinology, Ondokuz Mayis University Hospital, between 2000 and 2012. Pituitary tumor volume was calculated after performing measurements of tumor diameter in three orthogonal planes using Cavalieri's principle. VF test was performed with a Humphrey field analyzer 750 using a 4-mm² Goldmann size III stimulus. The mean age of the 23 patients (11 male/12 female) was 50.4 ± 11.9 years. 15 patients (65.2 %) had normal VF, two patients (9 %) had quadrantanopsia, three patients (13 %) had hemianopsia and three patients (13 %) had three quadrantanopsia. Among the patients with normal VF, four patients had a suprasellar mass that was elevating the chiasm and spreading along the optic tracts. We also observed VF defects typical of a chiasmal compression even though no suprasellar extension was detected in a few cases. Tumor volume of the patients with VF defects was significantly larger than tumor volume of patients with normal VF (p = 0.02). Tumor volume is an important parameter in VF defects. Advanced neuroimaging assesments should always be complemented in patients even with normal VF.

Lymphocyte subpopulations in Sheehan's syndrome.

The role of autoimmunity in the development of Sheehan's syndrome is obscure. There are a limited number of studies investigating the immunological alterations accompanying Sheehan's Syndrome. Our objective was to evaluate lymphocyte subsets in these patients. We conducted a cross-sectional clinical study. Cytofluorometry was used for the immunophenotyping of peripheral blood leukocytes from patients with Sheehan's syndrome followed up in the endocrine clinic during 2005-2009. Fifteen consecutive patients (mean age 61.6 ± 11.3, range 34-75 years) and 25 healthy controls (mean age 56.7 ± 10.6, range 34-80 years) were included. There was no statistically significant difference between the groups in terms of mean age. The percentages of CD19(+), CD16(+)/56(+), CD8(+)28(-), γδTCR(+), CD8(+); the total lymphocyte counts; and the ratio of CD8(+)28(-)/CD8(+)28(+) were similar (p > 0.05) between patients and controls. Whereas the leucocyte counts (p = 0.003), the percentage of CD3 (+) DR (+) (p < 0.001), CD8(+)28(+) (p = 0.030), CD4(+)CD25(+) (p = 0.007), the ratio of CD3 (+) DR(+)/CD3 (p < 0.001) were higher; the percentage of CD3 (p = 0.020), CD4 (p < 0.001) and the ratio of CD4/CD8 (p = 0.006) were lower in patients with Sheehan's syndrome compared to healthy controls. There was a positive correlation between the duration of illness and the percentage of CD3(+)DR(+) (r = 0.53, p = 0.03) expression. Some peripheral lymphocyte cell subsets show marked variation in patients with Sheehan's syndrome in comparison to matched healthy subjects, which may have implications for altered immune regulation in these patients. High CD3 (+) DR (+) expression that correlates with the duration of illness in Sheehan's patients is suggestive of an ongoing inflammation accompanying the slow progression of pituitary dysfunction in Sheehan's syndrome. It is not clear if these cellular alterations contribute to the cause or consequence of pituitary deficiency in Sheehan's syndrome.

The prevalence of non-classic adrenal hyperplasia among Turkish women with hyperandrogenism.

The prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16-46 years (mean: 23.2 ± 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population.

The evaluation of serum cystatin C, malondialdehyde, and total antioxidant status in patients with metabolic syndrome.

BACKGROUND: This study was designed to determine if serum cystatin C (Cys C) levels are affected by metabolic syndome and whether they correlate with lipid peroxidation and total antioxidant status (TAS) in this disorder. MATERIAL/METHODS: Cases with metabolic syndrome diagnosed according to the ATP III criteria (18 females, 12 males) were compared with healthy control subjects (20 females, 17 males) matched by age and gender. Plasma Cys C, malondialdehyde (MDA), and TAS levels were studied. RESULTS: Compared with the controls, Cys C and MDA levels were significantly higher (p<0.001 and p<0.001, respectively), whereas TAS was lower (p<0.001) in metabolic syndrome patients. A significant positive correlation between MDA and Cys C (r=0.308, p<0.05) and a significant negative correlation between TAS and Cys C levels (r=-0.358, p<0.01) were found. CONCLUSIONS: As Cys C and MDA levels increased but TAS decreased, Cys C may be an important indicator in the pathogenesis of metabolic syndrome.

Do we still need the TRH stimulation test?

OBJECTIVE: To evaluate the diagnostic value of the thyrotropin-releasing hormone (TRH) stimulation test in the diagnosis of central hypothyroidism in patients with Sheehan's syndrome. DESIGN: TRH stimulation test was performed in 72 patients with Sheehan's syndrome. Basal free triiodothyronine (fT(3)) and free thyroxine (fT(4)) levels were measured. Serum thyrotropin (TSH) concentration was determined before and 30, 60, 90, and 120 minutes after 200 mug TRH IV bolus injection. The peak TSH values <5.5 microIU/ml were defined as inadequate response. A peak TSH at 60 minutes or later was considered as delayed response. If TSH (60 minutes after peak), was more than 40% of the peak value it was considered as prolonged response. The diagnosis of central hypothyroidism (CH) was made if either serum fT(4) concentration was subnormal with an inappropriately low serum TSH concentration or inadequate response to TRH stimulation test and/or a delayed or prolonged response to TRH stimulation test. MAIN OUTCOME: Fifty-six (77.7%) of the patients had low serum fT(4) and fT(3) levels with an inappropriately low serum TSH levels were defined as CH (CH0 group). Ten (13.8%) patients with normal and low-normal fT(4) levels had no response and/or delayed or prolonged response to TRH stimulation test (CH1group). Six (8.3%) patients had fT(3), fT(4), and TSH levels within normal limits and peak TSH responses >/=5.5 microIU/ml consistent with euthyroidism (euthyroid group). Thus, 66 (91.6%) of 72 patients with Sheehan's syndrome had CH. Although fT(4) levels were within normal reference range, TRH stimulation test revealed that 10 (13.8%) of these had CH. CONCLUSION: TRH stimulation test is useful in the diagnosis of central hypothyroidism, especially in whom fT(4) and/or TSH is low-normal and known to have hypothalamo-pituitary pathology.

Posterior pituitary function in Sheehan's syndrome.

OBJECTIVE: We studied posterior pituitary function in 27 patients with Sheehan's syndrome and 14 controls. DESIGN: All patients were investigated by water deprivation test and 26 of them by 5% hypertonic saline infusion test. None of the patients had symptoms of diabetes insipidus and all patients were on adequate glucocorticoid and thyroid hormone replacement therapy before testing. RESULTS: According to dehydration test, 8 (29.6%) patients had partial diabetes insipidus (PDI group) and 19 (70.3%) had normal response (non-DI group). During the 5% hypertonic saline infusion test, the maximal plasma osmolality was higher in PDI (305 +/- 4.3) and non-DI (308 +/- 1.7) groups when compared with controls (298 +/- 1.7 mOsm/kg; P < 0.005), but the maximal urine osmolality was lower in PDI group (565 +/- 37) than in non-DI (708 +/- 45) and control (683 +/- 17 mOsm/kg) groups (P < 0.05). The osmotic threshold for thirst perception was higher in PDI (296 +/- 4.3) and non-DI (298 +/- 1.4) groups when compared with control group (287 +/- 1.5 mOsm/kg) (P < 0.005). Basal plasma osmolalities were also higher in PDI (294 +/- 1.0) and non-DI (297 +/- 1.1) groups than in controls (288 +/- 1.2 mOsm/kg; P < 0.001). CONCLUSIONS: Our findings demonstrated that patients with Sheehan's syndrome have an impairment of neurohypophyseal function. The thirst center may be affected by ischemic damage and the osmotic threshold for the onset of thirst in patients with Sheehan's syndrome is increased.

Investigation of hypothalamo-pituitary-gonadal axis and glucose intolerance among the first-degree female relatives of women with polycystic ovary syndrome.

OBJECTIVE: To assess the glucose intolerance and the hypothalamo-pituitary-gonadal (HPG) axis in the first-degree relatives (FDRs) of patients with polycystic ovary syndrome (PCOS). DESIGN: Clinical study of the female FDRs of patients with PCOS. SETTING: Outpatients at endocrinology department of a university hospital. PATIENT(S): Seventy FDRs of PCOS patients and 20 healthy women were evaluated. INTERVENTION(S): Basal hormonal investigations, buserelin test, and 75-g oral glucose tolerance test (OGTT) were performed. MAIN OUTCOME MEASURE(S): Basal hormone levels were measured. Additionally, insulinogenic index, glucose and insulin responses to OGTT, and FSH, LH, E(2), and 17-OHP responses to buserelin test were obtained. RESULT(S): Four (5.7%) of the FDRs showed impaired glucose tolerance, and the FDRs had significantly higher fasting plasma glucose (P<.05) and basal insulin (P<.01) than control subjects. Peak and area-under-the-curve (AUC) insulin (P<.001) and AUC glucose (P<.05) responses to OGTT were also significantly higher in the FDRs than in control subjects. The FDRs showed higher insulinogenic index than the control subjects (P<.001). The FDRs had significantly (P<.05) higher LH and DHEAS levels and lower (P<.005) 17-OHP levels than the control subjects. Peak (P<.05) and AUC (P<.01) LH responses to buserelin testing were lower in the FDRs than in the control subjects while peak (P<.05) and AUC (P<.01) E(2) responses to buserelin were higher in the FDRs than in the control subjects. CONCLUSION(S): These data support the hypothesis that FDRs of PCOS patients may have insulin resistance and the HPG axis is more susceptible than in control subjects. The FDRs also have an increased prevalence of hyperandrogenism and high DHEAS levels compared with the background population.

Investigation of the skin characteristics in patients with severe GH deficiency and the effects of 6 months of GH replacement therapy: a randomized placebo controlled study.

OBJECTIVE: The presence of GH receptor in human skin and its appendages suggests a direct effect of GH on skin characteristics. The skin is usually thin and dry in patients with GH deficiency (GHD). Sheehan's syndrome classically refers to postpartum hypopituitarism and GH is one of the earliest pituitary hormones lost. While severe GHD is a well-established feature of Sheehan's Syndrome, skin characteristics and the effects of GH replacement therapy (GHRT) have been investigated neither in Sheehan's syndrome nor in other disorders of GHD. The aim of this study was to investigate the skin characteristics, including the sebum content, hydration (skin capacitance), transepidermal water loss (TEWL), pH and skin temperature, and particularly the effects of 6 months of GHRT on these parameters in GH deficient patients with Sheehan's syndrome. PATIENTS AND DESIGN: Sixteen severely GH deficient women with Sheehan's syndrome (48.1 +/- 10.9 years), and 20 age and menopausal status similar women as control subjects were included. Ten patients received recombinant GH for 6 months (treatment group) and 6 patients received placebo (placebo group) during this period. Skin properties were measured at baseline and after 6 months of GHRT using noninvasive and well-established measuring methods. RESULTS: At baseline the skin capacitance was significantly decreased on the forehead and forearm, and sebum content was significantly decreased on forehead in patients with Sheehan's syndrome compared to control subjects (P < 0.05). In the treatment group there was a significant increase in sebum content on forehead after 6 months of GHRT compared to the baseline value (P < 0.05). However there were no significant changes in other parameters including sebum content on the forearm, TEWL, Ph, skin capacitance and temperature of both the forearm and forehead. In the placebo group there were no changes in any of the evaluated parameters after 6 months of treatment compared to baseline values. CONCLUSIONS: The present study clearly shows that the sebum content on the forehead and skin hydration of the forehead and forearm are significantly decreased in GH deficient patients with Sheehan's syndrome. However 6 months of GHRT significantly increased only the sebum content on the forehead. These data suggest that GH and/or IGF-I may have a modulatory role on several skin characteristics.

Prevalence of polycystic ovarian changes and polycystic ovary syndrome in premenopausal women with treated type 2 diabetes mellitus.

OBJECTIVE: To investigate the prevalence of polycystic ovary syndrome (PCOS) and polycystic ovary (PCO) among premenopausal women with type 2 diabetes mellitus (DM). DESIGN: Case-control study of women with type 2 DM. SETTING: Tertiary referral university hospital. PATIENT(S): Ninety-two premenopausal women with DM, >or=30 years of age, and 20 age- and body mass index-matched healthy premenapousal eumenorrheic women were recruited into the study. INTERVENTION(S): An oral glucose tolerance test was performed according to the American Diabetes Association criteria for each healthy woman. After an overnight fasting, blood samples were obtained for the determination of fasting blood glucose, LH, FSH, free T, androstenedione (A(4)), 17-hydroxyprogesterone (17-OHP), DHEAS, PRL, free T(4), TSH, E(2), and sex hormone-binding globulin (SHBG) levels. A GnRH analog (buserelin) test was carried out in 36 patients with DM and PCO (including PCOS subjects), 20 patients with DM without PCO or PCOS, and 20 healthy subjects. MAIN OUTCOME MEASURE(S): The prevalence of PCO and PCOS in women with type 2 DM. RESULT(S): Fifty-seven (62%) of diabetic patients had normal ovaries, 31 (33.7%) had PCO, and 4 (4.3%) had PCOS. The women with DM (n = 92) and healthy women (n = 20) had similar basal A(4), FSH, E(2), 17-OHP, free T, and DHEAS levels. The LH and SHBG levels were lower and the hirsutism score higher in diabetic patients than in healthy women (P<.05). Peak and area under the curve LH and FSH levels after buserelin testing were significantly higher in healthy women than in the patients (P<.05). Peak A(4) levels after buserelin were significantly higher in the patients than in the healthy women (P<.05). Ovarian volume was significantly greater in the patients with PCO (10.1 +/- 0.7 mL) than in the healthy women (7.0 +/- 0.9 mL) (P<.05). CONCLUSION(S): We conclude that PCO but not PCOS is a common finding in premenopausal women with type 2 DM. Suppression of gonadotropins, particularly LH secretion, may play a role in the absence of increased PCOS prevalence among type 2 diabetic patients.

The effect of Helicobacter pylori on insulin resistance.

Helicobacter pylori causes a lifelong infection in the stomach after exposure. H. pylorihas been shown to be associated with peptic ulcer and gastric cancer development. Moreover, it is held responsible for some other nongastric diseases. Among them, coronary heart disease attracts much debate. Many studies have demonstrated a close relationship between insulin resistance and atherosclerosis. Chronic inflammation and alterations in counter-regulatory hormones are deemed responsible for the etiology of insulin resistance. We aimed to examine the effect of H. pylori on insulin resistance. Sixty-three patients were enrolled in the study. Patients were divided into two groups according to H. pylori presence. HOMA-IR (homeostasis model assessment of insulin resistance) level was used to assess insülin resistance. Thirty-six patients were H. pylori positive and 27 were H. pylori negative. There was no difference between the two groups with regard to age, gender, or body mass index. HOMA-IR level was 1.73+/- 1.1 in the H. pylori-negative group, whereas it was 2.56 +/- 1.54 in the H. pylori-positive group (P < 0.05). This study provides the first direct evidence for an association between chronic H. pylori infection and insulin resistance.

Nephropathy and retinopathy in type 2 diabetic patients living at moderately high altitude and sea level.

BACKGROUND: High-altitude-induced hypoxia results in various diseases, such as chronic mountain sickness and high altitude retinal edema, and may affect severity and incidence of some cardiovascular diseases. In order to evaluate the effects of moderately high altitude on diabetic nephropathy and retinopathy, a cross-sectional study was planned. MATERIAL METHOD: Long-term type II diabetic residents of sea level (n=75, 38 male, 37 female, mean age 51.9+/-10.5 in Trabzon and Zonguldak cities) and moderately high altitude (h = 1,727 m, n = 73, 28 male, 45 female, mean age 48.3+/-12.1, Van city) were compared. RESULTS: No difference was observed in terms of age, gender, diabetes duration, body mass index, smoking, systolic, diastolic, and mean arterial blood pressure values, serum glucose levels, cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, hemoglobin, HbA1C, hypertension control, or blood pressure medications and retinopathy incidence. Mean 24 h protein excretion (210.0+/-139.9, 127.8+/-112.1 mg; P=0.00), proteinuria prevalence (57.5% versus 33.3%, p=0.003), and serum creatinine levels (1.04+/-0.22 versus 0.84+/-0.21, p = 0.00) were significantly higher in the highlanders, glomerular filtration rate (GFR) was significantly lower in sea level (SL) patients (90.9+/-26.5 versus 83+/-21.1, p=0.05). CONCLUSION: Tendency to diabetic nephropathy as indicated by higher proteinuria and creatinine levels is increased among type 2 diabetic patients living at moderately high altitude. Prospective studies are needed to confirm these findings.

Prostatic adenocarcinoma metastasis in the thyroid gland.

Metastasis from prostate to thyroid gland is very uncommon. Here we report a 77-year-old man who was admitted to the hospital because of a nodular goiter. A fine-needle aspiration biopsy of the nodule showed metastatic prostatic adenocarcinoma. This is the second case of a metastatic prostate carcinoma to the thyroid gland.

Serum levels of tumor necrosis factor-alpha, interleukin-6 and interleukin-8 are not increased in dyspeptic patients with Helicobacter pylori-associated gastritis.

INTRODUCTION: Helicobacter pylori (H. pylori) is a non-invasive microorganism causing intense gastric mucosal inflammatory and immune reaction. H. pylori-induced gastric mucosal cytokine overproduction has been clearly documented previously. The stomach has a large surface area and continuous spill-over of locally produced cytokines into the blood stream is a possibility. There are few and conflicting data on circulatory proinflammatory cytokine levels in patients with H. pylori infection. MATERIALS AND METHODS: Forty-two dyspeptic patients were enrolled into the study. The presence of H. pylori infection was diagnosed with antral histopathologic examination. After overnight fasting; serum samples were obtained from each patient to determine circulating interleukin (IL)-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha) levels. RESULTS: H. pylori was shown in 30 cases using Giemsa stain in antral histopathologic evaluation. Twelve cases were negative for H. pylori staining. Both the age and sex distribution had an insignificant difference in both H pylori-positive and H. pylori-negative groups. The mean circulatory levels of IL-6, IL-8 and TNF-a in both groups were not different. The situation was same in respect to the serum levels of these cytokines and the degree of inflammation, H. pylori density and activation scores according to Sydney classification. CONCLUSION: We could not show elevated circulatory levels of IL-6, IL-8 and TNF-alpha in H. pylori-infected cases. We believe that H. pylori-related cytokine activation become concentrated on gastric mucosa and this pathogen-induced local inflammatory cascade does not cause changes in circulatory levels of these cytokines. Moreover, there is no correlation between the levels of serum cytokines and Sydney parameters.

Rhabdomyolysis associated with gemfibrozil-colchicine therapy.

OBJECTIVE: To report a case of rhabdomyolysis possibly due to combination therapy with colchicine and gemfibrozil. CASE SUMMARY: A 40-year-old man with amyloidosis and hepatitis B virus-related chronic liver disease was admitted to the university hospital because of fatigue, lack of appetite, dark brownish urine, and myalgia for 2 weeks. The patient was receiving colchicine and gemfibrozil. Elevations of serum creatine kinase, lactate dehydrogenase, and aspartate aminotransferase concentrations with myalgia were compatible with the diagnosis of rhabdomyolysis. DISCUSSION: To our knowledge, myopathy and rhabdomyolysis due to a combination of colchicine and gemfibrozil therapy have not been previously reported. Preexisting mild renal failure, hepatitis B-related chronic liver disease, and amyloidosis may be contributing risk factors for the development of rhabdomyolysis in this patient. An objective causality assessment revealed that the adverse drug event was possible. CONCLUSIONS: Patients receiving combination therapy with colchicine and gemfibrozil, especially those with renal and hepatic dysfunction, should be monitored for rhabdomyolysis, and concomitant colchicine and gemfibrozil therapy should be considered in the differential diagnosis of rhabdomyolysis.