High adenosine deaminase activity in the pleural effusion of a patient with Legionnaires' disease

Abstract:   Although Legionnaires' disease (LD) is frequently accompanied by pleural effusion, the characteristics of pleural effusions in LD have not been well studied. Levels of adenosine deaminase (ADA) activity in pleural fluid >40 IU/L have a high sensitivity (81–100%) and specificity (83–100%) for tuberculosis. ADA activity in pleural effusions due to LD has not been previously reported. The case of a patient with LD complicated by a pleural effusion with high ADA activity is reported. In countries where the prevalence of tuberculosis is high and pleural fluid ADA activities are frequently measured, LD should be included in the differential diagnosis of an exudative pleural effusion with high ADA activity.     

Nationwide Experience With Off‐Label Use of Interleukin‐1 Targeting Treatment in Familial Mediterranean Fever Patients

Objective

Approximately 30–45% of patients with familial Mediterranean fever (FMF) have been reported to have attacks despite colchicine treatment. Currently, data on the treatment of colchicine‐unresponsive or colchicine‐intolerant FMF patients are limited; the most promising alternatives seem to be anti–interleukin‐1 (anti–IL‐1) agents. Here we report our experience with the off‐label use of anti–IL‐1 agents in a large group of FMF patients.

Methods

In all, 21 centers from different geographical regions of Turkey were included in the current study. The medical records of all FMF patients who had used anti–IL‐1 treatment for at least 6 months were reviewed.

Results

In total, 172 FMF patients (83 [48%] female, mean age 36.2 years [range 18–68]) were included in the analysis; mean age at symptom onset was 12.6 years (range 1–48), and the mean colchicine dose was 1.7 mg/day (range 0.5–4.0). Of these patients, 151 were treated with anakinra and 21 with canakinumab. Anti–IL‐1 treatment was used because of colchicine‐resistant disease in 84% and amyloidosis in 12% of subjects. During the mean 19.6 months of treatment (range 6–98), the yearly attack frequency was significantly reduced (from 16.8 to 2.4; P < 0.001), and 42.1% of colchicine‐resistant FMF patients were attack free. Serum levels of C‐reactive protein, erythrocyte sedimentation rate, and 24‐hour urinary protein excretion (5,458.7 mg/24 hours before and 3,557.3 mg/24 hours after) were significantly reduced.

Conclusion

Anti–IL‐1 treatment is an effective alternative for controlling attacks and decreasing proteinuria in colchicine‐resistant FMF patients.

     

Comparison of the activities of Na(+),K(+)-ATPase in brains of rats at different ages

BACKGROUND: Na(+),K(+)-ATPase is known to be responsible for the ionic homeostasis in excitable tissues. The energy cost of Na(+),K(+)-ATPase activity is increased in the active brain, so it would be important to ascertain whether defects in brain metabolism in aging are associated with changes in the properties of Na(+),K(+)-ATPase. OBJECTIVE: The aim of this study was to investigate the influence of age on the Na(+),K(+)-ATPase activity in developing rat brains from the age of 1 day to 24-28 months. METHODS: Crude microsomal preparations were obtained from the brains of newborn (n = 8), 18-day-old (n = 8), 4- to 5-month-old (n = 12), and 24- to 28-month-old (n = 14) rats. Then the ATPase activity was measured and expressed as micromoles of inorganic phosphorus released per milligram of protein per hour. RESULTS: The increased tendency in brain Na(+),K(+)-ATPase activity from newborn to 18 days of age suggested that the Na pump is mature soon after birth. No significant differences could be detected in the enzyme activity between newborn and adult rats. In contrast, the Na(+),K(+)-ATPase activity in aged rat brains was found to be significantly lower than in the other age groups of rats tested (p < 0.001). CONCLUSION: Our results suggest that aging-induced inhibitions in the brain Na(+),K(+)-ATPase activity may be implicated in the depression of neuronal excitability and in the age-related impairments of cognitive functions.     

The effect of low-dose methotrexate on bone mineral density in patients with early rheumatoid arthritis

OBJECTIVE: The intent of this study was to assess the effect of low-dose methotrexate treatment on bone mineral density (BMD) in patients with early rheumatoid arthritis (RA). METHODS: Forty-six premenopausal women with early RA not previously treated with disease-modifying antirheumatic drugs or corticosteroid were randomized to 7.5 mg/week of methotrexate or 2 g/day of sulphasalazine for 18 months. Bone mineral density of the lumbar spine, femoral neck, and trochanter was measured using dual-energy X-ray absorptiometry (DEXA). Biochemical studies included serum calcium, phosphorus, total alkaline phosphatase, beta-2 microglobulin, parathyroid hormone and 25-hydroxyvitamin D(3) concentrations, spot urinary calcium, and 24-h urinary calcium excretion. Disease activity was assessed by modified disease activity score (DAS 28), and functional impairment was estimated by the Health Assessment Questionnaire. RESULTS: No significant difference in BMD of the lumbar spine, femur neck, or trochanter was observed at 18 months in either group. There was also no significant change in the biochemical parameters of both groups. CONCLUSION: Our findings suggest that low-dose methotrexate has no negative effect on BMD in premenopausal RA patients.     

Positive clinical outcomes of the saphenous vein interposition technique for ruptured popliteal artery aneurysm

Purpose

Popliteal artery aneurysms (PAAs) can be treated successfully by surgical and endovascular methods; however, the best treatment strategy for a ruptured PAA has yet to be established. We assessed the clinical results of using saphenous vein interposition to treat ruptured PAAs in our hospital.

Methods

The subjects of this study were seven men (average age 59 years, range 43–71 years), who underwent emergency surgery for a ruptured PAA at our hospital between January 2007 and November 2012. The patients were assessed after 1, 6, and 12 months, postoperatively.

Results

All included patients underwent saphenous vein graft interposition via a medial approach. No complications or graft thromboses were encountered in the immediate postoperative period. The patients were discharged after an average of 4 days postoperatively (range 3–5 days). The patients were followed up for an average of 32 months (range 2–60 months). The medium-term graft patency was 100 %. No patients suffered early or medium-term limb loss and there was no mortality.

Conclusion

Based on our positive results, saphenous vein graft interposition should be considered as the first choice of surgical treatment for a ruptured PAA.     

Up-regulation of TGM2 with ITGB1 and SDC4 is important in the development and metastasis of renal cell carcinoma

ObjectiveTissue transglutaminase (TGM2) up-regulation is involved in the progression and dissemination of carcinomas through β1 integrin (ITGB1) association. Given that TGM2 interaction with syndecan-4 (SDC4) on the cell surface is important in the activation of ITGB1 and integrin-mediated survival signaling, we investigated the roles of TGM2, ITGB1, and SDC4 in the development and metastasis of renal cell carcinoma (RCC).Material and methodsExpression levels of TGM2, ITGB1, and SDC4 mRNA were analyzed in primary tumor samples (n = 95) and their healthy counterparts in addition to control and RCC epithelial cell lines. TGM2 catalytic activity in 60 randomly selected patient samples was measured by enzyme-linked sorbent plate assay.ResultsTGM2 expression ratio showed a significant 2.9-fold decrease in 67 (70.5%) of the primary RCC tumors (P <0.0001) independent of clinical covariates, including tumor node metastasis (TNM) staging and histopathologic grading. For the remaining 28 (29.5%) tumors, a 1.95-fold increase was recorded in the TGM2 expression levels, which also showed a significant increase in ITGB1 and SDC4 expression levels in 82.6% of the overexpression cases (P <0.001). Up-regulation of TGM2 along with ITGB1 and SCD4 was associated with metastasis and a marked decrease in tumor necrosis. Consistently, RCC cell lines exhibited higher levels of TGM2 expression compared with the control epithelial cell line with a significant up-regulation of ITGB1 and SCD4 recorded for the metastatic lines.ConclusionsOur findings suggest that TGM2 up-regulation along with ITGB1 and SDC4 plays an important role in the development of RCC tumors and advanced RCC with metastasis.     

Horseshoe lung associated with scimitar syndrome and pleural lipoma

Horseshoe lung is a rare congenital anomaly characterized by the presence of unilateral pulmonary hypoplasia and a midline isthmus bridging the right and the left lung. Almost all cases of horseshoe lung are associated with the scimitar syndrome. The scimitar syndrome, sometimes called the congenital pulmonary venolobar syndrome, is a rare but well-described constellation of cardio-pulmonary anomalies. The characteristic abnormality is anomalous pulmonary venous return from a part of or the entire right lung to the inferior vena cava. We present a case of horseshoe lung associated with scimitar syndrome and pleural lipoma in an adult admitted for acute chest pain and chronic dyspnea.     

Evaluation of dynamic hyperinflation parameters and exercise capacity at maximal exercise in patients with COPD

Hyperinflation is an important limiting factor for exercise performance in patients with chronic obstructive pulmonary disease (COPD). Hyperinflation can be determined by measuring residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC) at rest, and by measuring inspiratory capacity (IC) and end-expiratory lung volume (EELV) at maximal exercise. This study aimed to evaluate changes in hyperinflation parameters on maximal exercise in subjects with COPD. Patients with clinically stable COPD (n= 43) and healthy controls (n= 14) were included. Subjects performed pulmonary function tests and an incremental exercise test on cycle ergometry. Statistically significant differences (p< 0.05) were found regarding exercise test parameters including exercise duration, maximum oxygen uptake, breathing reserve, maximum minute ventilation, and breathing pattern between groups. There was significant increase in EELV (p< 0.05) and decrease in IC (p< 0.05) at maximum exercise when hyperinflation parameters were compared at baseline and maximum exercise. Our results showed that hyperinflation was evident at maximal exercise, although there were no hyperinflation findings at rest in subjects with COPD. We believe that in patients with COPD, it is better to evaluate hyperinflation at maximal exercise than at rest.