Clinicopathological and epidemiological analysis of amyloidosis in Turkish patients.

BACKGROUND: The aim of the present study was to assess the correlation of immunohistochemical subtyping with clinical diagnosis in order to achieve useful epidemiological data regarding amyloidosis in Turkish patients. METHOD: We carried out immunohistochemical studies on 128 biopsies from various sites of 111 patients with biopsy-proven amyloidosis and, based on the results, classified the patients. We assessed the correlation of immunohistochemical subtype with clinical diagnosis and gathered epidemiological data. RESULTS: The sites most biopsied were kidney and rectum, followed by the testicle, liver, small intestine and bladder. Amyloid deposits showed positive staining with a single antibody in 120 biopsies. Pure amyloid A (AA) positivity was seen in 113 biopsies; six biopsies were positive for amyloid lambda (AL) and one for beta2-microglobulin (beta2MG). The clinical diagnoses of 81 patients (98 biopsies all AA positive) were suggestive of familial Mediterranean fever (FMF). Also AA positive were eight patients with tuberculosis, seven patients with rheumatoid arthritis, four patients with bronchiectasis and one patient with Crohn's disease. The biopsies from seven patients clinically suspected to have plasma cell dyscrasias were AL positive. One patient undergoing haemodialysis was beta2MG positive. Two patients without definite diagnoses showed double or triple positivity, which could not be interpreted and classified immunohistochemically. CONCLUSIONS: This study demonstrates that the predominant association of AA amyloidosis is with FMF. It also suggests that the routine immunohistochemical study of patients with amyloidosis who are of certain ethnic backgrounds suffices for classifying the subtype of amyloid fibril protein and the related disease.

Retroperitoneal abscess as a late complication following laparoscopic cholecystectomy.

BACKGROUND: Gallstone spillage during laparoscopic cholecystectomy is a relatively common occurrence. These intraperitoneal gallstones are considered to be harmless. Rarely, they may give rise to complications. Surgeons should retrieve spilled stones whenever possible. CASE REPORT: We report the case of a 75-year-old man with retroperitoneal abscess that developed 6 years following laparoscopic cholecystectomy as a late complication. The cavity, though it drained purulent material, was sterile in culture. Gallstones were found in the drain effluent. To our knowledge this is the first case report in English of such a delayed complication caused by spilled gallstones. CONCLUSIONS: Every effort should be made to avoid perforation of the gall bladder during its dissection. Whether the procedure should be converted to open surgery to retrieve all the stones is subject to debate.