The importance of serial measurements of cytokine levels for the evaluation of their role in pathogenesis in familial Mediterraean fever.

Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent fever of unknown origin, renal amyloidosis, peritonitis, pleuritis and/or synovitis. There have been many studies to elucidate the etiopathogenesis of FMF. IL-6 is a cytokine that can induce the formation of serum amyloid A and C-reactive protein, both of which are important in development of amyloidosis. IL-6 was determined to be strongly associated in the etiopathogenesis of periodic fever in Chinese-pei dogs. The dogs with this syndrome experience periodic fever, arthritis, renal amyloidosis, a clinical picture very alike of human FMF. Here, we aimed to study mainly whether IL-6 had a similar etiopathogenetic role in human FMF as in Chinese-pei dogs syndrome. The median IL-6 blood levels were found to be higher in patients with acute (n=8) FMF attack (1.85 U/ml) compared to those (n=33) with asymptomatic ones (1.0 U/ml) (p=0.16). There are mainly two results: first; the study should be designed with a larger sample size of patients with acute attack in order to alleviate underestimation of significance, second; sampling time may give various results because of dynamic changes of cytokine levels during acute attack period.

Helicobacter pylori seropositivity in patients with hyperemesis gravidarum.

OBJECTIVE: The aim of this study was to analyze the hypothesis that there was an association between hyperemesis gravidarum (HG) and Helicobacter pylori (HP) infection. METHODS: The study group consisted of 95 pregnant women with HG and 116 asymptomatic pregnant women who were admitted to our hospital between January 1997 and October 1998. Specific serum immunoglobulin G for HP was assayed in the sera of the study group after informed consent was obtained. Chi-square and Student's t-test were used accordingly for statistical analysis of the data. RESULTS: Serologically positive HP infection was detected in 87 of the 95 patients with HG (91.5%) whereas 52 of the 116 asymptomatic gravidas (44.8%) serving as the control group had positive antibody concentrations against HP. The ratio of HP positivity in pregnant women with HG was significantly higher than asymptomatic pregnant women (P < 0.001). The mean index percentages of IgG titers were 73.8 +/- 9.7% in the hyperemesis gravidarum and 25.8 +/- 5.6% control group (P < 0.01). CONCLUSION: HP infection seemed to be significantly associated with hyperemesis gravidarum in our pregnant patient population with hyperemesis gravidarum.

Reduction of adhesion formation with cross-linked hyaluronic acid after peritoneal surgery in rats.

OBJECTIVE: To examine the effectiveness of a cross-linked hyaluronan solution (auto-cross-linked polysaccharide [ACP] gel) for the prevention of postsurgical adhesions. DESIGN: A randomized blinded study using a rat model of laparotomy. SETTING: Surgical Research Laboratory in a university medical school. ANIMAL(S): Sixty-seven sexually mature rats. INTERVENTION(S): Standardized surgical trauma was induced in the rat uterine horn to induce adhesion formation. After trauma, group-1 animals (n = 23) received no treatment, group 2 (n = 21) received noncross-linked hyaluronic acid (HA), and group 3 (n = 23) received cross-linked HA applied on the lesion. MAIN OUTCOME MEASURE(S): Six weeks after laparotomy, repeat laparotomy was performed and the adhesions were scored according to Blauer's scoring system. RESULT(S): Overall, 84% of the untreated animals and 65% of the animals treated with noncross-linked HA presented with severe adhesions. The mean (+/-SEM) increase in the adhesion score was 2.46+/-0.23 in the untreated group, 2.23+/-0.29 in the group receiving noncross-linked HA, and 1.27+/-0.12 in the ACP gel group. CONCLUSION(S): ACP gel holds promise as a novel resorbable biomaterial for the reduction of postoperative adhesions after laparotomy.

Helicobacter pylori associated gastric pathology in patients with type II diabetes mellitus and its relationship with gastric emptying: the Ankara study.

Helicobacter pylori (HP) is the most common cause of nonerosive nonspecific gastritis. Gastric and duadenal ulcer both are found to be associated with HP infection. Another consequence of HP infection is that it may progress to chronic atrophic gastritis which is a well recognized risk factor for adenocarcinoma of the stomach. So by extension, HP infection can be accepted as a risk factor for gastric cancer. From this aspect, identification of risk groups is increasingly important. It is well-known that patients with diabetes mellitus are more prone to infection. Besides this, presence of gastroparesis diabeticorum may lead to bacterial overgrowth in the upper gastrointestinal (GI) tract. The present crossectional study was planned to study the presence of HP infection in diabetic patients with alterations in upper GI motility and to compare the results with healthy control group. Group I consisted of 51 patients with type II diabetes mellitus (as defined by National Data Group criteria) without any dyspeptic symptoms. Twenty-five age-matched healthy people served as a control in group II. Radionuclide-labelled solid meals were used to calculate gastric emptying time (GET). According to the results, patients in group I were divided into two groups. Patients with prolonged GET were grouped as group IA, while group IB consisted of patients with normal or shortened GET. Presence of HP gastritis is determined by histopathologic examination of endoscopic biopsy specimen. The results showed that the prevalence of HP gastritis in group I and II were 80.4% and 56% respectively and the difference was significant statistically (p: 0.03). In group IA, the prevalence of HP infection was estimated to be 88.2%, while in group IB it was 76.5% but the difference was not significant (p: 0.31). We have not found any correlation between HbA1c levels and the presence of HP infection in both group IA and IB (p values 0.26 and 0.15 respectively). We conclude that the prevalence of HP gastritis is higher in asymptomatic diabetic patients compared with healthy people. But there is no association between the alterations in GET and the presence of HP gastritis as indicated by our results. So prolonged GET may not be regarded as a specific pathogenic mechanism or a cause of HP infection in NIDDM patients.

Familial Mediterranean fever. No role of Mycobacterium tuberculosis in ten patients.

BACKGROUND: Tuberculosis (TB) and Familial mediterranean fever (FMF) are two common diseases in our region, Turkey. Both share some properties in common: Both cause AA type amyloidosis and have association with some immunological abnormalities. Upon incidentally observing Mycobacterium tuberculosis in bone marrow biopsies of three patients with FMF in a previous study, we intended to elucidate this association prospectively. MATERIAL AND METHODS: In this study, we examined prospectively 10 FMF patients, 5 male and 5 female, with a median duration of 31 years disease activity. All were under colchicine therapy. They had no sign of renal involvement. The bone marrow biopsies of these patients were examined for the presence of M. tuberculosis by Polymerase chain reaction (PCR), BACTEC culture and pathological stains. Pathological examination was performed for the existence of granuloma and amyloid deposition by hematoxylin-eosin, Crystal Violet and Congo red stains. RESULTS: The examination of all bone marrow specimens by the mentioned methods suggest that Mycobacterium tuberculosis has no role in the ethiopathogenesis of FMF. Although the patients had a positive family history of 60% for tuberculosis and in 80% of them with positive tuberculin skin test. CONCLUSIONS: We concluded that although there seemed to be a kind of association between both diseases, this relationship is not via the direct existence of bacteria itself. Considering high family history and skin test positivity, one should look for the presence of autoimmune mechanisms under this suspicious relationship between tuberculosis and FMF. Also, this is the first study examined the state of amyloidosis in the bone marrow at an earlier stage of FMF without overt renal findings.

PCR on disseminated tuberculosis in bone marrow and liver biopsy specimens: correlation to histopathological and clinical diagnosis.

Disseminated tuberculosis with negative pulmonary findings is a diagnostic problem. Histopathological studies of bone marrow (BM) and liver (LV) biopsies are the most reliable methods for diagnosis in such cases; however, their sensitivity is limited. In this retrospective study, 41 BM and 7 LV paraffin-embedded biopsy specimens from clinically (clinical response to antituberculous treatment after 6 months follow-up) and/or histopathologically diagnosed tuberculosis were analysed for the detection of Mycobacterium tuberculosis DNA by polymerase chain reaction (PCR). Two different primer sets, one based on the repeated IS6110 sequence of M. tuberculosis and the other based on the mtp40 gene region, were used for amplification. Histopathological and PCR studies were positive for M. tuberculosis in 12/41, and 30/41 in BM and 4/7, and 6/7 in LV biopsy specimens, respectively. As the control group, 17 BM biopsy specimens obtained from patients with a positive Mantoux skin test but no active tuberculosis were analysed. One BM biopsy out of 17 control cases was positive with PCR while none was consistent with TB histopathologically. In conclusion, PCR might be applicable and more reliable than histopathological studies for detection of tuberculosis in BM and LV biopsy specimens.