CYSTOID MACULAR EDEMA ASSOCIATED WITH LATANOPROST

Purpose: To report clinically, anotomically and angiographically documented cystoid macular edema (CME) associated with the use of latanoprost in 2 uncomplicated pseudophakic eyes. Methods: Retrospective rewiev of 2 patients who had history of latanoprost use and uncomplicated cataract surgery, described     

Sympathetic skin responses from postauricular region in Meniere's disease.

OBJECTIVE: To investigate the sympathetic nervous system activity in Meniere's disease (MD) by recording sympathetic skin responses (SSRs) from the postauricular region (PA). METHODS: Twenty-one patients with definite unilateral MD diagnosis and 12 healthy volunteers were studied by evoking right and left PA-SSRs with electrical stimulation of the left median nerve at the wrist in attack and interval periods of MD. Mean latencies and maximum amplitudes were used in statistical analyses. RESULTS: In unilateral definite MD patients, the mean latencies were longer and the maximum amplitudes were smaller on the involved ear side than those on the normal ear side (p<0.01 for both amplitude and latency) and than those from the controls (p<0.01 and p<0.05). In three patients, there was no detectable PA-SSR on the involved ear side while there were SSRs on the healthy side. In four patients, the responses were absent bilaterally during the attack period. CONCLUSIONS: There is a marked asymmetric sympathetic hypofunction in the area of the PA region of the involved ear in MD patients. SIGNIFICANCE: The PA region is a new site for recording sympathetic skin responses. PA-SSR is a useful tool to investigate sympathetic nervous system function in MD patients.     

Spastic paraparesis associated with portal-systemic venous shunting due to congenital hepatic fibrosis.

We report a case of progressive spastic paraparesis in a 45-year-old man with total portal-systemic shunting, which developed spontaneously due to congenital hepatic fibrosis. Cellular functions of the liver, except for an elevated blood ammonia level, were within normal limits, as is usual in congenital hepatic fibrosis. This case shows that spastic paraparesis following portal-systemic shunting may occur without liver failure.     

Bilateral adrenal hemorrhage associated with bilateral renal vein and vena cava thrombosis

Idiopathic bilateral adrenal hemorrhage with thrombosis of both renal veins and inferior vena cava are presented using US and CT in a newborn. To our knowledge such bilateral involvement of the adrenal glands and the renal veins have not been reported previously.     

Enhancement of immunogenicity of Jeg3 cells by ectopic expression of HLA-A*0201 and CD80

PROBLEM: The choriocarcinoma cell line Jeg3 suppresses immunity in vitro by secretion of soluble factors like leukemia inhibitory factor suppressing leukocyte activation. The cells lack expression of classical human leukocyte antigen (HLA)-A and -B alleles but express some HLA-C, and non-classical HLA-G and -E. Upon binding to killing inhibitory receptor on natural killer (NK) cells, HLA-G prevents activation of cytolytic activity. We investigated whether Jeg3 cells are capable of immune stimulation after complementation with classical HLA and T cell costimulatory signal CD80. METHOD OF STUDY: Jeg3 cells were transduced to express HLA-A*0201 and/or CD80. Parental Jeg3 or transfectants Jeg3-A2, Jeg3-CD80 or Jeg3-CD80-A2 were used to stimulate allogeneic resting and activated peripheral blood lymphocytes (PBL). The different cell lines were loaded with a HLA-A2-restricted Epstein-Barr virus (EBV) recall antigen peptide epitope and antigen presenting ability was examined. T cell lines specific for Jeg3 and transfectants were generated from HLA-A2 matched and nonmatched donors and compared for expansion, phenotypes and cytolytic activity. RESULTS: While all Jeg3 cell lines induced only marginal proliferation of resting T cells, phytohemagglutinin (PHA)-activated T cells were stimulated by CD80 or CD80-A2 expressing Jeg3. Only the transfectant Jeg3-CD80-A2 was capable of specific T cell stimulation by EBV recall antigen presentation. T cell lines of HLA-A2 non-matched donors stimulated with the Jeg3 transfectants showed significant expansion only when HLA-A2 and the costimulus CD80 were present. T cells from HLA-A2 positive donors did not expand significantly or differentially. No NK cells grew under any condition. In Jeg3-CD80-A2 stimulated T cells lines CD8+ cells expanded preferentially. These T cells exerted cytolytic activity toward all Jeg3 cell lines. CONCLUSION: Our data suggest that, in spite of immunosuppressive mechanisms, proliferative and cytolytic T cell responses are induced by Jeg3 cells when classical HLA- and/or costimulatory signals are present on the cells.     

Emergence of rifampicin resistance in methicillin-resistant Staphylococcus aureus isolated at a Turkish university hospital

Twenty-three rifampicin-resistant methicillin-resistant Staphylococcus aureus (MRSA) isolated in three wards at a university hospital in Turkey between June, 2000, and February, 2001, were studied for their genetic relatedness using a combination of antibiogram, coagulase serotyping, coagulase gene polymorphism (coa-RFLP), and pulsed-field gel electrophoresis (PFGE). They all expressed high-level rifampicin resistance (MIC, >256 mg/L) and were resistant to gentamicin, kanamycin, amikacin, ciprofloxacin, tetracycline, and cadmium acetate and were susceptible to fusidic acid, vancomycin, trimethoprim, and mupirocin. They belonged to the same coagulase serotype (serotype IV) and had identical coa-RFLP patterns. In contrast, PFGE generated nine banding patterns designated type A, types A1-A5, B, C, and D. The most common PFGE pattern (type A) and its subtypes (types A1-A5) were seen in 20 (87%) of the 23 isolates in the three wards. The results demonstrated the acquisition of rifampicin resistance by different MRSA clones and the spread of one clone among patients in the three wards.     

Adenosine deaminase activity in serum of patients with hepatitis -- a useful tool in monitoring clinical status.

BACKGROUND AND PURPOSE: The evaluation of adenosine deaminase (ADA) activity in sera of patients with hepatitis should be considered a useful tool in the monitoring of their clinical status. In this study, we aimed to determine the relationship between viral load, transaminase levels, and serum ADA levels in hepatitis B virus (HBV)- and hepatitis C virus (HCV)-infected patients. METHODS: Seventy three patients with hepatitis B, 71 patients with hepatitis C and 40 healthy individuals were included. Patients with HBV and HCV infections were classified into 3 groups according to viral load. Serum ADA levels were investigated by colorimetric assays. RESULTS: Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and ADA levels of HBV- and HCV-infected patients were higher than those of the control group. These differences were statistically significant for the levels of all enzymes in HCV-infected patients (p<0.05), and all except AST (p>0.05) in HBV-infected patients. ADA levels of HBV-infected patients with high viral loads were higher than those in HBV-infected patients with intermediate and low viral loads, and the difference was detectably significant between patients with high and intermediate viral loads. Evaluation of HCV-infected patients according to viral load showed no statistically significant relationship between viral load and serum ADA, ALT, and AST levels (p>0.05). HBV- and HCV-infected patients with high ALT and AST levels showed statistically significantly higher levels of ADA than patients with normal ALT and AST levels (p<0.001). CONCLUSIONS: We suggest that serum ADA levels are associated more with the level of serum transaminases than viral load in HBV- and HCV-infected patients. In the treatment of patients with hepatitis, serum ADA levels should be considered a useful tool for the monitoring of liver condition.     

Diabetes education: a chance to improve well-being of Turkish people with type 2 diabetes

To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program (n=126) or not (n=129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA(1c) level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program.     

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Tension-type headache in children: A clinical evaluation

BACKGROUND: Headache Society (IHS) criteria for episodic tension-type headache were included in the present study. Pain characteristics, associated symptoms, and stress-triggering factors were evaluated. Psychiatric and psychosocial evaluations were performed according to DSM-IV criteria. RESULTS: Pain was bilateral in 93.7% of patients and bitemporal in 50% of children. The intensity of pain increased with motion and stress in more than half of the patients, while pain decreased with rest and massage in 43.7% of patients. Ten of the 16 (62.5%) patients were diagnosed as having a psychiatric disorder. The most common stress-triggering factors were difficulty in adaptation at school and relationship problems with family members. All of the children reported 26 stress factors. Of these stress factors, 20 (76.9%) were reported by children diagnosed with psychiatric disorder. CONCLUSION: These results suggest that in children with tension-type headache a thorough psychiatric evaluation should be performed to rule out underlying psychiatric disorders.