Elevation of procalcitonin level in patients with pulmonary tuberculosis and in medical staff with close patient contact

BACKGROUND: Several studies have shown that serum procalcitonin levels increase conspicuously in acute and systemic inflammatory diseases. However, there is insufficient information concerning its activity in chronic infectious diseases such as tuberculosis. In this study, we aimed to assess serum level of procalcitonin in patients with active pulmonary tuberculosis and in medical staff at high risk due to close patient contact (high-risk staff). METHODS: For this purpose, 30 patients (6 female, 24 male) and 20 staff (8 female, 12 male) were evaluated. Twenty eight healthy blood donors (9 female, 19 male) made up the control group. RESULTS: Serum procalcitonin level in patients with tuberculosis was 0.76 +/- 0.20 ng/mL. Procalcitonin levels in active tuberculosis patients and staff were not significantly different (p=0.381); however, differences between active tuberculosis patients and control group were significant (p<0.001). In addition, serum procalcitonin levels were also different in staff and control groups (p<0.001). CONCLUSIONS: This study showed that procalcitonin levels increased both in patients with pulmonary tuberculosis and in the staff. This result considered that procalcitonin could be a good indicator of inflammation in patients with chronic diseases and in persons exposed to long-lasting infections.     

CT and MR imaging findings and their implications in the follow-up of patients with intracranial aneurysms treated with endosaccular occlusion with onyx

BACKGROUND AND PURPOSE: Our purpose was to describe the CT and MR features of intracranial aneurysms occluded with the liquid polymer Onyx. METHODS: At two centers, 35 aneurysms in 33 patients and 11 in nine patients were treated with the polymer. In 17 patients, adjunctive stents were placed at the aneurysm neck. All but three aneurysms originated from the internal carotid artery (ICA). Eighteen were giant; 15, large; and 13, small. Patients underwent pre- and postprocedural CT and/or MR imaging; MR angiograms (MRAs) were available in 22. In 35 patients (38 aneurysms), 3-month and/or 1-year follow-up angiograms were obtained for correlation with sectional images. RESULTS: Except in two small aneurysms, polymer filling created beam hardening artifacts on CT scans. In 10 aneurysms, the polymer did not fill the aneurysm sac entirely; five showed recanalization at follow-up. On MR images (all sequences), the polymer appeared hypointense, probably because of its tantalum content; it did not create artifacts. MRAs falsely suggested reduced or absent ICA flow in 11 of 22 patients, nine of whom with stents. In the rest, MRA provided results comparable to those of selective angiography. In 12 patients, postprocedural imaging revealed new lesions. CONCLUSION: Onyx appears hypointense on MR images, with no artifact, and it does not interfere with MRA except in patients with stents. MR imaging may reveal new parenchymal lesions, even in asymptomatic patients. In the immediate control and follow-up of polymer-treated aneurysms, MR imaging and MRA may be preferred. CT may show the degree of filling in the aneurysmal sac, but Onyx creates artifacts that hinder CT evaluation.     

Subtotal parathyroidectomy: a possible treatment for calciphylaxis

Calciphylaxis is a rare disorder in patients with chronic renal failure that is characterized by ischemic necrotic skin lesions. The prognosis is grave and mortality is high (80%). The precise mechanism of calciphylaxis is still unknown, but in addition to chronic renal failure, elevated parathyroid hormone levels appear to play a role. The role of parathyroidectomy in treating affected patients is questionable. In this article, we describe the case of a patient with chronic renal failure who developed rapidly progressive subcutaneous calcifications and ulcerations in the lower extremities. These lesions regressed following subtotal parathyroidectomy. We also review the literature on calciphylaxis, with a focus on treatment options.     

Radiotherapy in maxillary sinus carcinomas: evaluation of 79 cases

PURPOSE: The aim of this study is to evaluate the outcome of patients with maxillary sinus carcinoma after radiotherapy regarding local control, prognostic factors and morbidity of treatment. MATERIALS AND METHODS: Between January 1983 and December 1996, 79 cases of maxillary sinus carcinoma without any evidence of distant metastases, were treated with radiotherapy. RESULTS: Fifty-two patients (65.8%) were male and 27 (34.2%) were female. The median age was 57. Histologically 62% were epidermoid carcinoma, 32.9% were non-epidermoid carcinoma and 5.1% were unclassified. Sixteen patients (20.5%) had T2, 25 (29.8%) had T3 and 38 (49.7%) had T4 tumour while 13 patients (16.5%) had lymph node metastases. Fifty-nine patients (74.4%) underwent surgical resection followed by postoperative radiotherapy and 20 patients (25.3%) received radiotherapy alone. The median follow-up was 71 months; 5-year overall survival and local control rates were 53% and 54% respectively. Prognostic factors influencing the overall survival were histologic type (epidermoid carcinoma, p = 0.02), advanced T stage (p = 0.04), postoperative residual tumour (p = 0.002) and lymph node involvement (p = 0.01) whereas the factors influencing local control were histologic type (p = 0.05) and postoperative residual tumour (p = 0.005). Late radiation morbidity were cataract (11.4%), loss of vision (8.9%), trismus (5.1%) and hearing loss (2.5%). CONCLUSION: In maxillary sinus carcinomas high rates of local control can be achieved with surgery and radiotherapy. Postoperative radiotherapy can have a positive impact on local control and overall survival especially in patients with early stage tumour of non-epidermoid histology and without residual disease after surgery.     

Effect of BCG vaccination on cytokine mRNA expression in atopic children with asthma

BACKGROUND: To investigate whether a preexisting T(H2)-type immune response could be suppressed by BCG immunization in atopic children with asthma. METHODS AND RESULTS: We have used PCR to amplify reverse transcribed (RT) IFN-gamma and IL-5 mRNA expressed by peripheral blood mononuclear cells (PBMCs) in response to in vitro phytohemagglutinin A, purified protein derivative and Dermatophagoides pteronyssinus II stimulation from nine atopic children, both before and 8 weeks after BCG vaccination. We have demonstrated that IFN-gamma expression was induced in response to all stimulants (IFN-gamma/beta-actin) after the vaccination, whereas there was no expression before (P<0.001). Although there was a tendency to diminish in the expression of IL-5 mRNA in response to the stimulants, only PHA rendered a statistically significant decrease after the vaccination. CONCLUSIONS: These results provide some evidence of TH1 dominance after BCG administration in atopic children.     

Cranial MRI in Behçet’s disease: 134 examinations of 98 patients

Two observers, blinded to the patients neurological status, reviewed 134 MRI studies of 98 consecutive patients with Behçets disease (BD), to define imaging patterns and to look for any relationship between the MRI findings and the timing of the examination in patients with differing courses of disease. There were 43 patients with overt parenchymal central nervous system (CNS) involvement, 22 with attacks and remissions, 15 with secondary progressive and six with primary progressive disease; 14 had raised intracranial pressure (RICP). Of the remaining 41 patients without specific neurological complaints, 16 had abnormalities on examination (silent CNS involvement) and 25 did not. During an acute CNS attack, the most common finding was a large lesion in the brain-stem or basal ganglia, extending to the diencephalon. On MRI performed after remission of an acute attack or during secondary progression, the same sites were affected, but the lesions were smaller or scattered, with less clearly defined margins. In primary progressive disease or silent CNS involvement, the cerebral white matter was most commonly involved, but almost half the MRI studies were normal. The brain parenchyma was abnormal in only one of the patients with RICP. MRI was normal in all but three patients without clinical CNS involvement, in whom it showed a few millimetric white-matter lesions. Brain-stem atrophy was seen in 15 patients examined >1 year after an initial parenchymal CNS episode, with secondary progressive cases predominating.Part of this work was presented at the Eighth International Conference on Behçets Disease, Reggio Emilia, October 1998 and at the Eighth Meeting of the European Neurological Society, Nice, June 1998     

Stage-specific expression of Clast6/E3/LAPTM5 during B cell differentiation: elevated expression in human B lymphomas

We have identified a CD40-regulated gene, Clast6/E3/LAPTM5, by subtraction of cDNAs derived from resting and CD40 ligand-treated B cells. Clast6/E3/LAPTM5 is abundantly expressed in resting mature B cells but is rapidly and transiently repressed by treatment with CD40 ligand, a T helper signal that induces B cell activation. Using a fluorescence activated cell sorter, we have purified B-lineage cells into distinct populations based on their differential expression of cell surface markers. Clast6/E3/LAPTM5 was found to be highly expressed in progenitor and precursor B cells, downregulated in late pre-B and immature B cells, and upregulated again in mature B and the germinal center B cells. Interestingly, Clast6/E3/LAPTM5 was expressed at high levels in malignant B lymphomas. These results reveal stage-specific expression of Clast6/E3/LAPTM5 during B cell differentiation and implicates its possible involvement in B cell malignancies.     

The comparison of antibody response to influenza vaccination in continuous ambulatory peritoneal dialysis,hemodialysis and renal transplantation patients

BACKGROUND: The immune system in renal transplant (Tx), Continuous Ambulatory Peritoneal Dialysis (CAPD) and hemodialysis (HD) patients have been suppressed and antibody response to vaccination is weaker than that of the normal population. Additionally immune response to vaccination also differs from each other in aforementioned three groups resulting from different levels immunosuppression. In the present study, detection of antibody response to influenza vaccine as an indicator of the level of immunity in Tx, CAPD and HD patients was aimed PATIENTS AND METHODS: Forty-eight patients (17 Tx, 16 CAPD and 15 HD) and 10 healthy adults, as a control group were enrolled into the study. Purified, split-virus, commercial trivalent influenza vaccine (VAXIGRIP--Pasteur Merieux Connaught, single dose of 0.5 ml into the deltoid muscle) containing 15 microg of each hemagglutinin of A/Johannesburg/82/96 (H1N1), A/Nachang/933/95 (H3N2) and B/Harbin/07/94 (B) strains were administered to all subjects. Serum samples were collected before and 1 month after vaccination to determine antibody titers. Hemagglutination-inhibition test (HI) was applied for determination of antibody response. The antibody response against each strain was measured separately. In addition to measurement of antibody response, increments in antibody titer (n-fold increase in titer), proportion of patients with protective antibody levels and seroconversion levels were taken into account. Wilcoxon paired 2 test and Mann-Whitney U test were applied for statistical analysis. p < 0.05 was accepted as significance level. RESULTS: Significant increases in antibody titers for all three antigens were observed in the study groups after vaccination (p = 0.001). However, the increase in titer of H3N2 was lower in Tx, CAPD and HD patients than that of the control group (1.0-2.0 vs 5.00) (p = 0.01). The proportion of protective antibody titers and seroconvertions were increased after vaccination in all subjects. Proportions of patients with protective antibody titers after vaccination were lower in Tx, CAPD and HD groups in comparison to control group. CONCLUSION: Although antibody titers in Tx, CAPD and HD patients presented significant increases after vaccination, the proportions of patients with protective antibody titers were lower in comparison to control group. Tx, CAPD and HD patients should be vaccinated every year to be able avoid potential morbidity and mortality of the influenza infection. Trial of high dose vaccination protocols may be useful to increase the proportion of patients with protective antibody levels.     

A dose-response analysis for classical Kaposi's sarcoma management by radiotherapy

OBJECTIVE: To evaluate the dose-response relationship in classical Kaposi's sarcoma (CKS) patients treated with external beam radiotherapy. METHODS: Between 1993 and 2004, patients with CKS treated at the Department of Radiation Oncology, Gulhane Military Medical School, Ankara, Turkey were evaluated in this retrospective study. The median age at initial presentation was 60 years. First, we analyzed the overall response rates for normalized total dose 2Gy (NTD2Gy) of <20 Gy, 20 Gy, and >20 Gy. Secondly, we searched for whether better response rates could be obtained with the NTD2Gy of > or =20 Gy compared to the NTD2Gy of <20 Gy. RESULTS: There were 109 evaluable lesions in 18 patients. The median follow-up was 4 years. The overall response rates at the post-radiotherapy twelfth month were 88% for NTD2Gy of <20 Gy, 97% for 20 Gy, and 96% for NTD2Gy>20 Gy, which were not statistically different. The complete and partial response rates at 12 months were 93.2%, and 3.4% for NTD2Gy of > or =20Gy, and 64% and 24% for NTD2Gy of <20 Gy and these were statistically different (p=0.001). Late side effects of radiation therapy were acceptable in all but 4 patients with fibrosis and edema. CONCLUSION: This retrospective analysis showed that radiotherapy schedules with an NTD2Gy of 20 Gy and above by using local irradiation fields are effective in terms of complete response rates in the management of CKS compared to NTD2Gy of <20 Gy.