Nickel Sensitivity in Asthma Patients

Nickel sulphate frequently causes allergic contact dermatitis; less known effects are nasal inflammation (rhinitis) and bronchial asthma. In this study, we aimed to find if there is a relationship between asthma and nickel sensitivity. Asthmatic patient, non-asthmatic atopic, and healthy control groups were patch tested with nickel sulphate. Nickel sensitivity was more prevalent in the asthmatic patient group compared to the non-asthmatic atopic and healthy control groups.     

Patchy cerebral white matter edema in chronic renal failure

Bilateral patchy cerebral white matter edema was observed in two children with chronic renal failure. Uremia in one case and hypertension or hyponatremia in the other appeared to be the cause of the neurological and radiological findings.     

Effect of concomitant use of pentoxifylline and alpha-tocopherol with radiotherapy on the clinical outcome of patients with stage IIIB non-small cell lung cancer

We evaluated the effects of pentoxifylline (PTX) and alpha-tocopherol on the clinical outcome of 66 patients with stage IIIB non-small cell lung cancer in a randomized clinical trial. All patients received 46 Gy of external radiotherapy to the primary tumor and regional lymph, nodes with an additional 14-Gy dose to the primary tumor. Thirty-three of the 66 patients also received PTX (400 mg, three times daily) and alpha-tocopherol (300 mg, twide daily) during radiotherapy, followed by 400 mg of PTX and 300 mg of alpha-tocopherol daily for 3 mo after radiotherapy. The remaining 33 patients (control group) received radiotherapy only. After a mean follow-up time of 12 mo, 18 patients remained alive. During follow-up, there were local recurrences in 14 patients and distant metastases in 18 patients. In patients who received PXT and alpha-tocopherol, 1- and 2-yr overall survival rates were 55% and 30%, respectively, and median survival was 18 mo. In control patients, 1- and 2-yr overall survival rates were 40% and 14%, respectively, with a median survival of 10 mo. These differences were statistically significant (p=0.0175). In patients who received PXT and alpha-tocopherol, progression-free survival rates for 1 and 2 yr were 48% and 23%, respectively; median survival was 12 mo. In the control group, the corresponding rates were 24% and 18%; median survival was 8 mo (p=0.0223). We conclude that the use of PTX and alpha-tocopherol combined with radiotherapy offers a possible survival advantage in this patient population.     

The effect of scleral buckling surgery on corneal astigmatism, corneal thickness, and anterior chamber depth

PURPOSE: To evaluate the effect of scleral buckling surgery on corneal topography, corneal thickness, and anterior chamber depth. METHODS: Thirty-two eyes of 32 patients who underwent encircling buckling surgery for rhegmatogenous retinal detachment were included in the study. Fellow eyes comprised the control group. Orbscan II topography system was used to determine the changes in corneal topography, corneal thickness, and anterior chamber depth before surgery and 1 week, 1 month, and 3 months after surgery. Statistical analyses used in the study were independent t test, paired t test, one way analysis of variance, and correlation analyses. RESULTS: Postoperatively, mean central corneal astigmatism at 1 week, 1 month, and 3 months was 4.3 +/- 2.0 diopters (D), 3.3 +/- 1.6 D, and 3.1 +/- 1.0 D, respectively. The change between 1 week and 3 months was statistically significant. Central cornea was thickened at the first postoperative week. The thickness gradually decreased to the preoperative levels at 3 months. Anterior chamber depth decreased, and the anterior chamber remained shallow after the surgery. The comparison between preoperative (2.94 +/- 0.6 mm) and postoperative anterior chamber depth was statistically significant at 1 week (2.57 +/- 0.7 mm), 1 month (2.83 +/- 0.7 mm), and 3 months (2.73 +/- 0.6 mm). CONCLUSIONS: Corneal changes after scleral buckling surgery were mild to moderate and the cornea almost resumed its preoperative parameters in 3 months' time. However, the anterior chamber remained shallow during 3 months of follow-up.     

Intrasaccular combination of metallic coils and onyx liquid embolic agent for the endovascular treatment of cerebral aneurysms

OBJECT: The aim of this study was to report on a novel technique in which metallic embolization coils were combined with the Onyx liquid embolic agent in the aneurysm sac to achieve a more durable result after endovascular treatment. This therapeutic procedure was performed in selected cases in which, based on the authors' experiences, either coil embolization or Onyx alone would likely have failed. The authors report long-term clinical and angiographic follow-up results in 20 consecutive intracranial aneurysms treated using this combination for defined indications. METHODS: Twenty aneurysms in 20 patients were treated with a combination of embolic coils and Onyx. Four aneurysms were giant; 13, large; and three, small. This new technique was used when standard Onyx or coil treatment with balloon assistance was determined to involve a higher possibility of recanalization, because either an adjunctive stent insertion could not be performed or the Onyx technique could not be used due to an unsuccessful seal test or intraaneurysm balloon prolapse. In one case, an adjunctive stent was placed before coil placement and Onyx deposition to control the material in the sac of the aneurysm, which had a fusiform neck. All aneurysms were completely occluded after using this technique. No clinical or technical adverse events occurred in any of the cases. Follow-up angiography was performed in all patients: 3-year studies in six patients, 2-year studies in five, and 1-year studies in nine. None of these studies demonstrated aneurysm regrowth or parent artery occlusion. CONCLUSIONS: The combination of the embolic coils and the Onyx liquid embolic agent provides very durable aneurysm occlusion for defined indications.     

Role of bacillus Calmette-Guérin as an immunomodulator for the prevention and treatment of allergy and asthma

PURPOSE OF REVIEW: As an essential part of the hygiene hypothesis, the association between exposure to mycobacterial components and the prevention, development and severity of atopic diseases has not been fully understood. The current status on the causal-effect link of this relationship and the potential use of mycobacterial adjuvants as a preventive or disease-modifying modality in allergic diseases is reviewed in this article. RECENT FINDINGS: Data obtained from human and animal models indicate a discrepancy regarding the preventive and therapeutic effect of bacillus Calmette-Guérin in atopic diseases. Among the issues that require clarification include whether the distinction in T helper type 1/2 cells described in mice can be fully extrapolated to humans. Other factors involved could be caused by genetic variation, optimal timing, dose, route of delivery as well as environmental factors, which affect the degree of natural exposure to pathogenic or saprophytic mycobacteria. SUMMARY: Most of the evidence available to date suggests a need for an improved mycobacterial vaccine administered early in life, by means of alternative routes, preferentially mucosal. As switching away from the T helper type 2 immune response by inducing T helper type 1 is unable to explain the underlying mechanisms of action of mycobacterial antigens, it may be worthwhile to investigate whether T regulatory cells are induced in response to different mycobacterial adjuvants.     

Correlation of the Tei index with left ventricular dilatation and mortality in patients with acute myocardial infarction

The Tei index is an echocardiographic index of combined systolic and diastolic function, calculated as isovolumetric relaxation time plus isovolumetric contraction time divided by ejection time. The aim of this study was to define the correlation of the Tei index with left ventricular dilatation and mortality in patients with acute myocardial infarction (AMI). A total of 77 patients (58 men, 19 women) with a mean age of 53 +/- 12 years, who had presented with an AMI in our clinic between June 2001 and February 2002 were compared with a control group of 88 healthy subjects (63 men, 25 women) with a mean age of 55 +/- 6 years. Echocardiographic evaluation was carried out within 24 hours and the third month of AMI, using a 3.5 MHz probe with pulse wave Doppler recordings by the adult cardiac mode of an Acuson C 256 echocardiograph. There were statistically significant differences between the 2 groups in all echocardiographic parameters, except mitral A wave. Thirteen patients died during the follow-up period of 3 months. The Tei index was significantly higher in the patients who died compared with those who survived (0.70 +/- 0.10 versus 0.61 +/- 0.10; P < 0.001). The patients who had heart failure after AMI had a mean Tei index value of 0.76 +/- 0.27, whereas the patients who did not have heart failure after AMI had a significantly lower Tei index value of 0.60 +/- 0.32 (P < 0.05). Patients were divided into 2 groups according to their Tei index. Patients with a > 0.60 Tei index had significantly higher end-systolic and end-diastolic volumes compared to patients with a < 0.60 Tei index (P < 0.001 for both) in the acute phase of AMI. Within 3 months, patients with a Tei index < 0.60 had a significant reduction in end-diastolic volumes (P < 0.01), whereas the end-diastolic volumes did not change significantly in patients with an index > 0.60 (P = 0.19). The Tei index is an important indicator of left ventricular dysfunction and death after AMI. A greater Tei index at the onset of AMI is associated with a higher incidence of subsequent cardiac death, CHF, and progressive LV remodeling.     

Lack of association between the Glu298Asp polymorphism of endothelial nitric oxide synthase and slow coronary flow in the Turkish population

BACKGROUND:

Coronary endothelial dysfunction plays an important pathogenetic role in patients with slow coronary flow (SCF). No data exist regarding the possible contribution of the Glu298Asp polymorphism genotype of the endothelial nitric oxide synthase (eNOS) gene to human SCF in the literature.

OBJECTIVE:

To investigate the association between SCF and the Glu298Asp polymorphism of the eNOS gene.

METHODS:

The study population consisted of 85 consecutive patients. The patient group included 66 patients with angiographically proven normal coronary arteries with SCF, and 19 subjects with normal coronary arteries with no SCF. The thrombolysis in myocardial infarction frame count was used for the diagnosis of SCF. The Glu298Asp polymorphism was determined by polymerase chain reaction and restriction fragment length polymorphism.

RESULTS:

The baseline characteristics were similar between the two groups, except for high-density lipoprotein cholesterol, which was higher in the SCF group than in the controls. The genotype distribution of Glu298Asp was as follows: GG 26%, GT 56% and TT 12%, where G is guanine and T is thymine. There was no difference in the frequency of the various genotypes or the alleles in patients with SCF versus normal controls.

CONCLUSIONS:

The Glu298Asp polymorphism genotype of the eNOS gene is not a risk factor for SCF in the present study population.     

Irinotecan combined with infusional 5-fluorouracil and high-dose leucovorin for the treatment of advanced gastric carcinoma as the first-line chemotherapy

BACKGROUND: Because of insufficient activity and high toxicity of current chemotherapy regimens in advanced gastric cancer (AGC), there is a need for newer regimens. METHODS: Twenty-five chemonaive patients with AGC have been treated with FOLFIRI regimen consisting of irinotecan 180 mg/m(2) over 30 min on day 1 combined with leucovorin 200 mg/m(2) over 2 h followed by 5-fluorouracil 400 mg/m(2) as bolus and 600 mg/m(2) as a 22-hour infusion on day 1 and 2. The treatment was administered every 14th day until progression or intolerable toxicity. RESULTS: Twenty-five patients (17 male, 8 female; 22 patients with PS 0-1 and 3 patients with PS 2), median age 54 (range 25-77), received a total of 230 courses of chemotherapy (median 9; range 1-18). Objective responses were observed in 9 patients (36%), all being partial. Median progression-free survival, 1- and 2-year progression-free survival rates were 8.6 months, 28.4% and 15.3%, respectively. Median overall survival, 1- and 2-year overall survival rates were 11.6 months, 48.0% and 17.8%, respectively. As serious adverse events, grade 3-4 neutropenia was observed in 5 patients (20.0%), grade 3 diarrhea in 4 patients (16.0%). No treatment-related death occurred. CONCLUSION: FOLFIRI regimen is an active regimen with acceptable toxicity for the treatment of AGC.