Decreased vitamin D levels in patients with familial mediterranean fever

Familial mediterranean fever (FMF) is an autosomal recessive disorder caused by mutations in the FMF gene (MEFV). The gene causing FMF, designated MEFV, encodes a protein called pyrin or marenostrin that is expressed mainly in myeloid bone marrow precursors, neutrophils, and monocytes. Since there are several etiological factors, FMF is the most common periodic fever syndrome. However, it is still unknown what triggers or ends these periodical attacks. As a pleiotropic hormone, vitamin D has immunomodulation effects. The aim of this study was to evaluate the vitamin D levels in FMF patients. The study group was comprised of 26 patients diagnosed with FMF (men/women: 12/14), and 34 healthy control (men/women: 17/17). Vitamin D levels in FMF patients and healthy controls were 11.05 ± 7.11, 17.15 ± 6.49, respectively. FMF patients had significantly decreased vitamin D levels compared with healthy controls (P < 0.001). In conclusion, it is thought that vitamin D deficiency in FMF patients may trigger the attacks. Further studies with larger patient populations need to hold to investigate the vitamin D deficiency in patients with FMF and that may assist to clarify the mechanism behind the colchicines resistant cases.     

Presentation of a device used by elderly women with prolapse in eastern part of Turkey

OBJECTIVE: Presentation of a device used by three elderly women with prolapse in eastern part of Turkey. METHOD: Information about device is obtained by face to face interview technique. Microbiologic examination of the device and vaginal cultures were performed. RESULTS: Three women with genital polapse using an ancient device were found incidentally and information about device, their knowledge about genital prolapse, and solutions were obtained. CONCLUSION: By the help of related media and women health organizations the women especially who live in rural area should be educated about reproductive health care and if necessary health policies revisions should be considered.     

The effect of topical insulin application on the healing of acute tympanic membrane perforations: a histopathologic study

The aim of the present study was to investigate the effects of insulin on the healing of acute traumatic tympanic membrane (TM) perforations by observing the duration of perforation closure clinically and by examining the TM thickness, fibroblastic reaction, neovascularization and collagenization histologically. In all, 24 adult healthy guinea pigs were used. TM perforations, about 2 mm in diameter were made in the pars tensa of each ear. The perforations in the right ears of the guinea pigs (study group) were treated with 1 IU of regular insulin (Humulin-R^® 100 IU/ml, Lilly) daily topically. The left ears of the guinea pigs (control group) were treated with saline solution daily. The treatments were continued until the each perforation closed. The animals were examined with otomicroscopy at first, third, fifth and seventh days. TM specimens were obtained after the animals were decapitated under deep anesthesia by an intraperitoneal injection of sodium pentobarbital (0.5 ml/100 g) 3 and 7 days after wounding. Histologically, the epithelial and mucosal layers were examined. Finger-like projections, the edema of the LP, neovascularization of LP, fibroblastic activity of LP, inflammatory cell presence of LP, collagenization ratios of LP were evaluated. In the study group; LP fibroblastic reaction positivity and LP collagenization positivity was significantly higher than the control group (P < 0.001 and P < 0.05). Topical insulin treatment may be more beneficial in the treatment of atrophic membrane, which is a sequel of perforation, when tried in various dosages and time intervals.     

Gated myocardial perfusion scintigraphy in children with myocarditis: can it be considered as an indicator of clinical outcome?

PURPOSE: Myocarditis is an inflammation of the heart muscle and represents a challenge for diagnosis and treatment. On account of the lack of sensitivity and specificity of routine cardiac tests, there is a need for accurate diagnostic imaging. The aim of this study is to review the role of gated Tc-methoxyisobutylisonitrile myocardial perfusion scintigraphy (G-MPS) in the diagnosis and follow-up of the patients with myocarditis in comparison with gallium scintigraphy. MATERIALS AND METHODS: Thirteen patients with a clinical diagnosis of myocarditis were included in the study. All underwent rest G-MPS and the images were then evaluated by quantitative perfusion single-photon emission computed tomography and quantitative gated single photon emission computed tomography software program. Visual evaluation of perfusion was performed as well as analysis of motion with thickening function [expressed as summed rest score, summed motion score, and summed thickening score (STS)] with calculation of ejection fraction (EF) and lung-to-heart (L/H) ratio. Eight patients underwent Ga scintigraphy. Clinical, echocardiography, and cardiac enzymes (creatinine kinase-MB, myoglobulin, troponin T, brain natriuretic peptide) data were gathered from the patients' charts. Clinical outcome was grouped according to prognosis. Spearman's correlation (SC) test was used for comparison analysis. RESULTS: Myocardial perfusion defects were observed in eight patients. Perfusion defects in the left ventricle involve a mean of 7.25% (range: 1-11%), whereas wall motion abnormality on G-MPS was more prominent, which showed to be a better marker for myocardial inflammation and necrosis. The Ga scintigraphy findings were normal in all, but two. The G-MPS EF (33+/-21%) was slightly lower than the echocardiography EF (40+/-15%), but with close correlation (SC coefficient: 0.635). Comparison of scintigraphic findings with clinical parameters showed that summed motion score with G-MPS EF and STS with L/H ratios were highly correlated (0.932 and 0.622, respectively). The maximum brain natriuretic peptide and L/H ratio with STS were highly correlated with the patients' outcomes (SC coefficient: -0.621, 0.821, and 0.579, respectively), as well. CONCLUSION: Tc-methoxyisobutylisonitrile G-MPS is therefore helpful in providing additional diagnostic and prognostic information in patients with myocarditis.     

Presence of high grade tertiary Gleason pattern upgrades the Gleason sum score and is inversely associated with biochemical recurrence-free survival

ObjectivesTumor heterogeneity is a common finding and led to realization of a tertiary Gleason component (TGC) in prostate cancer. In an attempt to further investigate its prognostic value, we analyzed the association of tertiary Gleason pattern in Gleason score ≤ 7 tumors with pathologic stage and biochemical disease-free survival.Material and methodsA total of 331 radical prostatectomy specimens were analyzed retrospectively. The primary, secondary, and the tertiary patterns were evaluated by reviewing all of the pathologic slides. TGC was defined as Gleason grade pattern 4 or 5 for Gleason score < 7 tumors and Gleason grade pattern 5 for Gleason score 7 tumors. The pathologic prognostic factors, (extraprostatic extension, seminal vesicle and lymph node invasion, surgical margin status) of Gleason score < 7, 3+4, and 4+3 tumors with or without TGC were compared. Biochemical recurrence-free survival (BRFS) was calculated using Kaplan-Meier method with log rank test, and the influence of TGC was assessed in a Cox regression model.ResultsTGC observed more frequently with higher Gleason scores (21% of the GS < 7 cases, 23% of the GS 3+4 cases, and 58% of the GS 4+3 cases). In terms of adverse pathologic prognostic factors and BRFS, GS < 7 tumors with TGC behaved significantly worse than GS < 7 tumors without TGC (P = 0.01 and P = 0.001, respectively) with properties similar to GS 3+4 tumors without TGC. Gleason score 3+4 and 4+3 tumors without TGC were statistically similar and had better features than corresponding tumors of same Gleason score with TGC. Furthermore, Gleason score 7 tumors with TGC had similar features with GS 8–10 tumors. During follow-up, 73 (22%) subjects had PSA recurrence. In the Cox regression model TGC was an independent variable for BRFS (HR = 2.63, 95% CI = 1.39–4.98, P = 0.003).ConclusionAccording to the present study, 3 different prognostic groups were observed; good prognostic group: GS < 7, intermediate prognostic group: GS < 7+TGC, GS 3+4, and GS 4+3, and finally bad prognostic group: GS (3+4)+TGC, GS (4+3)+TGC, GS > 7. Presence of a TGC appears to upgrade the total score and adjuvant treatment decisions may further be refined by considering the tertiary pattern.     

Increased frequency of familial Mediterranean fever in northern Turkey: a population-based study

Familial Mediterranean fever (FMF) is a systemic relapsing autoinflammatory disorder occurring in populations originating from the Mediterranean basin, mainly Turks, Levantine Arabs, Sephardic Jews, Druze, and Armenians. The prevalence of FMF shows considerable geographical variation. In Turkey, the prevalence rates were reported as 0.0027–0.25%. This field survey was conducted in different regions to investigate the frequency of FMF in a northern province of Turkey. This study was conducted in 70 areas (12 urban and 58 rural) in the province of Tokat, which is in northern Turkey. The population of Tokat was reported to be 828,000 at the last census in Turkey in 2000, about 530,000 for individuals aged >18 years (). Mean age of 1,095 (541 male and 554 female; urban 555 and rural 540) subjects was 41 ± 17 (range 18–95 years). FMF frequency in this study was 1/123 (0.82%, 95 CI: 0.40–1.61). Mean age of patients were 27 years (20–41) and mean age of symptoms were 16.3 years (11–23). In conclusion, the frequency of FMF in this study was 1/123 (0.82%) which was higher than expected. This rate is the highest frequency of FMF reported from Turkey. Further large sample studies are needed to define to true prevalence of FMF in Turkey.     

Carotid Endarterectomies With PTFE Patch Angioplasty

Surgical treatment of carotid stenosis has proved to be superior to medical treatment in many studies. However, debate continues on the issue of surgical techniques. Closure of the arteriotomy site remains to be one of these concerns. This study aims to evaluate the results of CEA with PTFE patch angioplasty in a prospective non-randomized way. Reports on 22 patients who had undergone CEA with PTFE patch angioplasty between January 1999 and September 2000 in the Medical Faculty of Istanbul University were reviewed. Follow-up studies with Duplex ultrasonography were completed. One of the patients (5%) suffered from a TIA and another one (5%) from wound haematoma. The mean operation time was 83.64 ± 34.07 min (45–160 min). No restenosis was detected during the follow-up period. Although PTFE patch angioplasty prolongs the operation period in CEA procedures, it is a safe method, which prevents the restenosis of the operated carotid artery that might make reintervention necessary.     

Collagen ultrastructure and TGF-beta1 expression preserved with aminoguanidine during wound healing in diabetic rats

Advanced glycoxidation end products have been implicated in delayed diabetic wound healing. In this study, we evaluated the effects of aminoguanidine, which is an advanced glycation and nitric oxide (NO) synthase inhibitor, on extracellular matrix protein expression, collagen configuration, and nitrite/nitrate levels in wounds of diabetic rats. Sixteen Wistar male rats were made diabetic by streptozotocin. Of these, eight rats were given AG (aminoguanidine bicarbonate (AG) (group DAG) in their drinking water, and eight rats were followed as diabetic paired controls (group D). Eight healthy rats were followed as the healthy control group (group H). At the eighth week, a 2 x 2 cm area full-thickness skin defect was created. The degree of contraction of the open wounds was evaluated for 2 weeks duration. On the 15th postoperative day, wound surface areas were measured, and wound specimens and blood samples were collected. The shrinking percentage of the wounds was small in both groups H and DAG compared with group D (p < 0.05). Similar to healthy rats, the aminoguanidine-treated diabetic rats had very strong transforming growth factor (TGF)-beta1 expression in granulation tissue and intact skin in comparison with diabetic controls. In the diabetic group, the intact skin demonstrated sparsely distributed regular collagen fibers in the granulation zone, and the regular pattern of collagen fibers was lost. In conclusion, aminoguanidine improves wound healing, restores growth factor TGF-beta1 expression, and preserves collagen ultra structure, whereas it has no prominent effect on NO levels within wound tissue in diabetic rats.