Erkan Yilmaz

Helicobacter pylori infection and skin disorders.

Helicobacter pylori is a Gram-negative bacterium that has been linked to peptic ulcer disease, gastric lymphoma, and gastric carcinoma. Apart from its well-demonstrated role in gastroduodenal diseases, some authors have suggested a potential role of Helicobacter pylori infection in several extra-intestinal pathologies including haematological, cardiovascular, neurological, metabolic, autoimmune, and dermatological diseases. Some studies suggest an association between Helicobacter pylori infection and skin diseases such as chronic idiopathic urticaria and rosacea. There have also been few case reports documenting association between Helicobacter pylori and psoriasis vulgaris, Behçets disease, alopecia areata, Henoch-Schönlein purpura, and Sweets syndrome. However, more systematic studies are required to clarify the proposed association between Helicobacter pylori and skin diseases; most of the studies do not show relevant relationships of these diseases with Helicobacter pylori infections. This review discusses skin diseases that are believed to be associated with Helicobacter pylori.

The relation between human leukocyte antigen (HLA) distribution and intestinal obstruction and adhesions in childhood: preliminary report

Abstract To investigate the association between the human leukocyte antigen (HLA) system and adhesions causing intestinal obstruction in childhood in order to determine whether HLA profiles can be used to identify and screen individuals at risk for intestinal adhesions, clinical and laboratory evaluations were done in a total of 42 (F:M = 27:15) patients. The mean age was 6.11 ± 3.2 years (0.6–13 years). The patients were tested for HLA phenotype in two groups; the HLA phenotype distribution and relative risk (RR) for adhesions were determined. The study patients were children operated upon due to acute abdominal emergencies. Group 1 included patients who needed readmission after the surgery due to intestinal obstruction (n = 19), group 2 patients had no readmission for any reason following surgery (n = 23). Of the 19 patients in group 1, 9 were treated only medically and 10 needed surgical intervention. Among the patients in whom medical treatment was initiated (n = 14), 5 needed surgery during follow-up. There was an increased RR for certain HLA subtypes (A24 [9], HLA11, DR11 [5], B22) in patients presenting with intestinal obstruction due to adhesions. Among these, A24 (9) and DR11 (5) were statistically significant (P < 0.05) compared with the control group. Several possible mechanisms could link the HLA system with disease, especially those in which the immune response is suspected to be involved, but the questions of how the inflammatory response is initiated and the role of proinflammatory cytokines remain unclear. Future research developments are likely to focus on increased understanding of the molecular biology of the major histocompatibility complex and its biological function in the immune response and adhesion formation and intestinal obstruction. It is possible that HLA profiles can be used to identify individuals at risk for intestinal adhesions in the future.

Familial Acromegaly: A Familial Report and Review of the Literature

Familial acromegaly without features of multiple endocrine neoplasie type 1 (MEN 1) is an exceptional clinical entity. We report in this article three cases of acromegaly due to pituitary macroadenomas without any other endocrinopathy in a family. A 31‐year‐old woman (subject A) and her 34‐year‐old sister (subject B) with elevated basal rolactin (PRL) levels, elevated growth hormone (GH) levels during the oral glucose tolerance test (OGTT) and a pituitary adenoma in Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) were diagnosed as acromegaly. Subject A was treated only with radiotherapy and Lysuride. Subject B underwent transsphenoidal microsurgical extirpation 15 years ago. 11 years later her 24‐year‐old son (subject C) also presented with typical signs of acromegaly, elevated basal PRL level and elevated GH levels during OGTT. A pituitary macroadenoma was identified by MRI and he also underwent transsphenoidal adenomectomy. Pathology reports confirmed the diagnosis of GH‐secreting pituitary adenoma in subject B and C. Immunocytochemistry revealed that tumours of subject B (> 20% of tumour cells) and C (> 50% of tumour cells) were positive for GH. Tumours of subject B (> 10% of tumour cells) and C (> 50% of tumour cells) also exhibited immunoreactivity for PRL. On investigation of histocompatibility antigens, it was observed that the subject A, B, and C shared the same haplotypes [HLA A24(9), HLA B13(6), HLA B35, HLA DQ7(3), HLA DR13(6)] and so it is very possible that investigation of HLA antigens in patients with pituitary tumour, contributes to better identification of its familial nature and frequency. Here we describe an acromegaly family and the distributions of HLA antigens.

Analysis of HLA antigens in Turkish sarcoidosis patients.

Background: Sarcoidosis is a systemic granulomatous disorder associated with high CD4+cell activity, without any detectable pathogen. Clustering in families occurs, and the existence of a genetic predisposition to sarcoidosis is widely accepted. There are differences among different ethnic groups. Methods: We studied HLA polymorphisms in 64 Turkish patients with biopsy proven sarcoidosis. The control group was taken of 160 donor candidates of kidney transplantation within the same period. Results: Fifty-one patients were female, and 13 were male. The mean age was 39 ± 6.1 years. Frequency of HLA A2, A9, A24 (9), A25, A69 (28), B12, B22, B38, B49 (21), DR4, and DR14 antigens were significantly higher, and frequencies of HLA B7 and DR7 were significantly less in sarcoidosis patients. Clustering in some families were also noted in our study. Conclusions: This study implies a genetic predisposition to sarcoidosis in the Turkish population. Clustering in some families should be kept in mind.

The Frequency and Associated Factors for BK Virus Infection in a Center Performing Mainly Living Kidney Transplantations

Purpose: BK virus (BKV) nephropathy has increasingly become an important cause of morbidity in renal transplant recipients. We evaluated the frequency and associated factors for BKV infection in a center performing mainly living donor transplantations over a long time period. Methods: One hundred consecutive renal transplant patients were included. Quarterly visits were planned to examine urine for decoy cells and to measure the BKV DNA in the blood and urine. Renal biopsy was performed in case of deteriorated allograft function. Serological examinations for BKV immunoglobulin G (IgG) were performed in donors. Results: Throughout the entire follow-up period, the rates of viruria, viremia, and the positivity of decoy cells were 12%, 6%, and 13%, respectively. The negative and positive predictive values of decoy cells were 93.1% and 69.2%, respectively, for viruria, and 99.2% and 45.5%, respectively, for viremia. Biopsy-proven BKV nephropathy was observed in 1 patient. The BKV IgG was positive in all living donors. Viruria and viremia were associated with deceased donor transplantation, acute rejection, and pulse steroid therapy. In addition, viremia was associated with antithymocyte globulin therapy and a short duration of the posttransplant period. Conclusions: The frequency of BKV infection was lower in our transplant unit compared to previous reports. Reduced doses of immunosuppression seem to be the main factor that may explain the reduced frequency. However, an active screening strategy is still of importance for this patient group.

KOROZİV MADDE İÇİMİNE BAĞLI ÖZOFAGUS DARLIĞI GELİŞİMİ VE HLA İLİŞKİSİNİN İNCELENMESİ

Amac: Koroziv maddeye bagli ozofagus yanigi olusan olgularda ozofagus darligi gelisimi acisindan fark olabilmektedir. Bu calismada, o zofagus darl igi olusumunda Human Lokosit Antijen (HLA) tipine gore bir farklilik olup olmadiginin arastirilmasi amaclandi. Gerec ve Yontem: Koroziv madde alimi sonrasi yapilan ilk endoskopide grade 1 ve uzeri ozofagus yanigi saptanan olgular geriye donuk olarak degerlendirildi. Grup 1 ozofagus darligi gelisen 10, Grup 2 ise o zofagus darl igi gelismeyen 10 olgudan olusturuldu. Tum olgulardan kan ornegi alinarak HLA antijen tiplendirmesi ve istatistiksel analiz yapildi. Bulgular: Yas ortalamasi 4,75 yil (2-10 yil) idi. HLA antijenlerine gore; grup 1’de HLA-DRB1 ’ 11 antijeni, grup 2’de ise HLA-A3 antijeni sayisal olarak daha yuksek bulundu. Ancak istatistiksel olarak anlamli degildi. S onuc: Calismada iki grup arasinda HLA antijenleri acisindan anlamli fark bulunamamistir. On rapor niteligindeki bu calisma, HLA ozofagus darligi arasindaki ileri calismalara yol gosterici olabilir. Olgu sayisinin artirilmasi ile koroziv o zofagus darl iklarini n erken tan i ve tedavisinde HLA antijenlerinin rolu hakkinda daha kesin bilgiler edinilebilecegini dusunmekteyiz.

Kidney allocation expert system with case-based reasoning

Experts in fields of organ transplantation have to make crucial decisions based on medical, social, moral and ethical factors. The paper describes the kidney allocation expert system KARES-CBR. Our system consists of two main components. Traditional expert system part uses rule-based knowledge. These rules contain general medical knowledge, such as blood group and antigens matching rules. Another group of rules contains decision making rules related to social and ethical information about organ transplantation. After decision making, the expert system component generates the list of medically suitable patients for the transplantation of an available organ. Another part of the system collects the archive of previous successful organ transplantation cases. This historical data are used in case-based reasoning part of the system. Using different metrics, the system calculates the similarity values for kidney transplantation of selected patients relative to the previous successful transplantations. As a result, it selects the best suitable patient for organ transplantation. The system is implemented as an expert system shell and the different criteria and parameters can be easily modified. The system was tested on real data in the University hospital.