Pure red cell aplasia as presentation of systemic lupus erythematosus: antibodies to erythropoietin.

In this case report we describe two patients with pure red cell aplasia (PRCA) as an initial manifestation of systemic lupus erythematosus (SLE). Antibodies to erythropoietin were determined, by an ELISA method developed in our laboratory, in frozen serum obtained from one of the patients. A high titer of antibodies to erythropoietin was detected in serum obtained before treatment with high dose intravenous immunoglobulin (IVIG). The antibody titer declined after successful treatment. This observation suggests that antibodies to erythropoietin may contribute to the pathogenesis of SLE associated PRCA.

The genetic polymorphism of aminolevulinate dehydratase (ALADH) in Greece.

The distribution of phenotypic and allelic frequencies of aminolevulinate dehydratase (ALADH) in different areas of Greece is reported. The frequencies of the allele ALADH1 and ALADH2 in Greece are 0.955 and 0.0455, respectively.

Value of ascitic fibronectin and cholesterol concentration in the differentiation between malignancy-related and non-malignant ascites.

In this prospective study, we tried to evaluate various "humoral tests of malignancy" regarding their efficiency of discriminating between malignancy-related and non-malignant ascites. Fibronectin, total protein, number of cells, LDH, pH, specific gravity and cytology were compared in the ascitic fluid of 51 patients with malignancy-related and 52 patients with non-malignant ascites; patients with tuberculous peritonitis were not included. Ascitic fluid cholesterol was determined in 36 of 51 malignancy-related and in 37 of 52 non-malignant ascites. Cytology and fibronectin were found 100% specific with diagnostic efficiency 87.5% and 94.2% respectively under optimal conditions. Cholesterol was neither sensitive nor specific. It is concluded that fibronectin was a valuable test for malignancy-associated ascites.

GC and C3 serum groups in ulcerative colitis.

The phenotypes and allele frequencies of two serum protein systems (GC and C3) were studied in 91 consecutive patients with ulcerative colitis and compared with healthy controls. No significant differences were found as far as GC was concerned. However, significant differences were observed in C3: the C3*F allele and C3FS phenotype were more frequent in patients than in controls.

Changes in blood glucose induced by upper GI diagnostic endoscopy: the influence of various premedications.

In this study we measured the blood glucose before and after diagnostic upper GI endoscopy as an index of the stress induced by the procedure. The possible influence of various premedications in the blood glucose was also studied. One hundred and twenty consecutive non-diabetic patients of both sexes aged 20-75 years were randomly allocated into four groups (A,B,C,D) according to the premedication used. Sixty non-diabetic patients, who were not endoscoped, were allocated into three groups (C1, C2, C3) and served as controls. Blood glucose increased significantly in the patients but not in the controls. No correlation was found between the changes in the blood glucose and the time needed for the endoscopy. Changes in the blood glucose did not differ among the patients (F = 0.214; p = 0.886) irrespective of the premedication; however the increase was numerically less when 10% lidocaine spray was used as a premedication (Groups A and C). It is concluded that diagnostic upper GI endoscopy induced a significant increase in blood glucose, irrespective of the premedication. This increase seemed to be mainly the result of the stress induced by the irritation of the pharynx during the intubation.

Non-cardia gastric adenocarcinoma and Helicobacter pylori infection.

The seroprevalence of IgG antibodies to Helicobacter pylori (Hp-Ab) was studied in 47 patients (29M, 18F, mean age +/- SD: 62.44 +/- 12.63 years) with non-cardia gastric carcinoma using an enzyme-linked immunosorbent assay. Controls were: a) 50 healthy people well-matched with the cancer patients; b) 50 patients with dyspepsia well matched with the cancer patients. Hp-Ab were detected in 72.3% of patients with gastric carcinoma, in 68% of healthy people and in 88% of dyspeptics. No significant associations were found between H. pylori infection and gastric cancer patients as a whole (odds ratio: 1.23, 95% CI: 0.514-2.95). In addition, no significant associations were found between H. pylori infection and the various subsets of cancer patients. These findings do not support an association between H. pylori infection and non-cardia gastric carcinoma in Greece.

A recently recognized entity associated with the treatment of acute promyelocytic leukemia: the retinoic acid syndrome.

All-trans-retinoic acid is an effective induction treatment for acute promyelocytic leukemia. Although retinoic acid is well tolerated by the majority of patients with this disease, a potentially fatal complication of this kind of treatment has been reported: "the retinoic acid syndrome". We describe this syndrome, which occurred in one of our patients and was successfully treated by the administration of dexamethasone.

Serum protein markers (Hp, GC, C3) in patients with colon cancer.

The phenotypes and gene frequencies of three serum protein systems--Hp, GC and C3--were studied in 184 consecutive patients from all over Greece with colon cancer. Healthy Greeks studied previously in our department served as controls. No significant differences were found between patients and controls concerning GC and C3. Significant differences were found in the Hp system; the frequencies of the Hp*1 gene and the Hp 1-1 phenotype were significantly higher in patients than in controls.

Herpes simplex virus types 1 and 2 and cytomegalovirus in peptic ulcer disease and non-ulcer dyspepsia.

The prevalence and the serum levels of IgG antibody to Herpes simplex virus type 1 or 2 (HSV1, HSV2) and to cytomegalovirus (CMV) were studied by ELISA in patients with active peptic ulcer -- duodenal and gastric -- and non-ulcer dyspepsia. Two hundred and forty-two consecutive patients with endoscopically confirmed active peptide ulcer -- 170 duodenal ulcers, 72 gastric ulcers -- and 95 consecutive patients who fulfilled the criteria for the diagnosis of non-ulcer dyspepsia were included in the study. The patients, aged 17-80 years, were well matched for age and sex. Antibody to cytomegalovirus was found in 83% of duodenal ulcer, 85% of gastric ulcer and 75% of non-ulcer dyspepsia patients; differences were not significant. The prevalence of HSV1 antibody was significantly higher in patients with duodenal ulcer than in those with non-ulcer dyspepsia (p < 0.025); the prevalence of HSV2 antibody was significantly higher in patients with duodenal or gastric ulcer, than in those with non-ulcer dyspepsia (p < 0.05, p < 0.01, respectively); however, antibody levels (mean optical density) to the viruses studied were similar for all groups of patients. These results provide some evidence that HSV might be implicated in the pathogenesis of peptic ulcer disease.

Preliminary observations in the fasting serum gastrin in patients with duodenal ulcer; further evidence of the "clearing" effect of omeprazole on H pylori?

Thirty patients with active duodenal ulcer who were Helicobacter pylori positive (HP+) by HLO test and by histology (Giemsa stain) were given omeprazole (OME) 20 mg/d for a two-week period. Estimation of fasting serum gastrin concentration (RIA) was performed before treatment and 24 hours after the last dosage of OME, and HP was searched for an antral biopsies at the end of the treatment as well. Mean fasting serum gastrin concentration increased significantly after treatment in all patients studied (p less than 0.05). However, the increase remained significant only in those patients who continued to be HP+ while no significant increase was observed in those who became HP-. The results could be considered as further evidence of the 'clearing' effect of Omeprazole on HP.

Fibrinogen and antithrombin III blood levels fluctuations during isoniazid or isoniazid plus rifampicin administration.

Nineteen randomized patients, treated with isoniazid (INH, CAS 54-85-3) for tuberculosis chemoprophylaxis or isoniazid plus rifampicin (RMP, CAS 13292-46-1) combination for tuberculosis therapy, were studied in order to explore the effects of these drugs on fibrinogen and antithrombin III blood levels. Other hepatic biology indices were also measured (aminotransferases, alkaline phosphatase, prothrombin time etc). The results suggested a relationship between INH or INH + RMP administration and fibrinogen as well as antithrombin III blood levels. The data indicate a protective effect of the RMP synchronous administration (by enzyme induction mechanisms) in the preservation of fibrinogen blood levels.

Cisapride, metoclopramide, and ranitidine in the treatment of severe nonulcer dyspepsia.

Cisapride, a prokinetic drug with a novel mechanism of action, was compared with another prokinetic drug, metoclopramide, and an H2-blocker, ranitidine, in the treatment of nonulcer dyspepsia. In a double-blind study, 60 patients with severe dyspeptic symptoms received cisapride 5 mg TID, metoclopramide 10 mg TID, or ranitidine 150 mg BID for 8 weeks. Symptoms were evaluated during treatment and 4 weeks after the end of therapy. All three drugs effectively controlled the symptoms of chronic functional upper gastrointestinal tract disorders. The prokinetic drugs, particularly cisapride, were significantly better than ranitidine in controlling symptoms, especially reflux symptoms. All three drugs were generally well tolerated; cisapride in particular was associated with fewer adverse effects.

Ranitidine and antacids in the prevention of duodenal ulcer relapse in Greece.

The present study was undertaken to compare the efficacy of ranitidine 150 mg/nocte with that of antacids taken "on demand" in the prevention of recurrence of duodenal ulcer (DU). Two groups (A, B) of patients with DU recently healed by ranitidine or antacids were studied. Patients of Group A (110) healed by ranitidine were put on maintenance treatment with ranitide, and patients of Group B (32) healed by antacids were given antacids "on demand" for a period of one year. Endoscopy was performed at the end of the 6th and 12th months, as well as whenever symptoms appeared. Patients were followed up clinically at 2-month intervals. Relapse rates of 11% (group A) and 34% (group B) were found at the end of the 6th month, (p less than 0.005), while the total relapse rates at the end of the 12th month were 19% and 47%, respectively (p less than 0.005). Recurrences were asymptomatic in 62% (Group A) and 27% (Group B) of patients. No significant side effects were observed. It is concluded that ranitidine 150 mg nocte is significantly superior to antacids "on demand" as far as the recurrence of DU is concerned.