Levent Demirturk

FAMILIAL MEDITERRANEAN FEVER. A REVIEW OF THE DISEASE AND CLINICAL AND LABORATORY FINDINGS IN 105 PATIENTS

BACKGROUND The diagnosis of familial Mediterranean fever still remains clinical, since no specific laboratory test exists, other than a molecular genetic test which is not widely available. AIM To evaluate the clinical findings in 105 Turkish patients; to compare these findings with those in the literature; and to make a brief review of the disease. METHODS A total of 105 familial Mediterranean fever patients were evaluated either retrospectively (for those diagnosed before 1997), or prospectively (for those after 1997). A diagnostic criteria set was used in addition to the clinical and laboratory findings that can be seen in familial Mediterranean fever, including the newly described manifestations. Previously selected clinical and laboratory parameters were observed for three consecutive days. RESULTS Of our patients, 88.5% were of Turkish, 3.8% of Armenian and 7. 6% of Jewish origin. Family history was positive in 87 (82.8%) patients. Involved site was peritoneum in 97 (92%), joints in 45 (42.8%) and pleura in 19 (18%). Frequency of myalgia/arthralgia was 24.7%, and skin findings were observed in 16. 1% of patients. Splenomegaly, not related to amyloidosis, was present in 21 (20%) patients. Meningeal, retinal or ovarian/testicular involvement was not observed. CONCLUSION Identification of familial Mediterranean fever gene has led to the application of a molecular genetic test for the diagnosis of Familial Mediterranean Fever. Until genetic methods become widely available, diagnosis will remain clinical. Thus, awareness of various clinical forms and of the correct usage of diagnostic criteria in various patient populations is important.

In vivo inefficiency of pentoxifylline and interferon-alpha on hepatic fibrosis in biliary-obstructed rats: Assessment by tissue collagen content and prolidase activity

Background and Aim: To evaluate the possible antifibrotic effects of two drugs, pentoxifylline (PTX) and interferon (IFN)‐α as well as their combination, on a bile‐duct‐ligated rat hepatic fibrosis model.

Effect of N-acetyl cysteine on Helicobacter pylori.

Background: Use of mucolytic agents that result in reduced mucous viscosity of the gastric mucous has been suggested to have an additive effect in curing Helicobacter pylori infection. Methods: Seventy H pylori–positive patients were given either eradication treatment consisting of 500 mg clarithromycin bid and 30 mg lansoprazole bid for 10 days plus 10 mL (400 mg) N-acetyl cysteine (NAC) liquid tid (AC group) or eradication treatment only (control group). The results were compared 1 month after the completion of the treatment. Results: Fifty-eight patients were available for statistical analysis. Of the 28 patients in the AC group, 14 (50.0%) eradicated the infection after treatment, whereas only 7 of 30 (23.3%) patients in the control group had negative results. The difference between the AC group and the control group was statistically significant (P = 0.034). In both groups, there was no difference in the number of smokers and in the eradication rates between smokers and nonsmokers. Eradication treatment with or without NAC caused no significant side effects in either group. Conclusions: Our findings suggest that NAC has an additive effect on the eradication rates of H pylori obtained with dual therapy with lansoprazole and clarithromycin. NAC does not have any known activity against H pylori, but it may improve the delivery of antibiotics at the site of infection due to its ability to reduce the thickness of the mucus.

CagA status in dyspeptic patients with and without peptic ulcer disease in Turkey: association with histopathologic findings.

CagA seropositivity is closely associated with that of vacuolating cytotoxin (VacA). Helicobacter pylori strains positive for both VacA and CagA were reported to be strongly associated with peptic ulcer disease. Different results reporting that cagA gene is not associated with more serious diseases, lowers the importance of CagA protein as a marker. In this study, CagA seropositivity is examined in Turkish peptic ulcer and nonulcer dyspepsia patients; histopathologic scores of CagA (+) and CagA (−) groups were compared.

Does N-acetyl cystein affect the sensitivity and specificity of Helicobacter pylori stool antigen test?

Background. N‐acetyl cystein, a mucolytic agent, might make Helicobacter pylori antigens shed more easily to stool, and might therefore contribute to the diagnostic accuracy of the Helicobacter pylori stool antigen test. The aim of this study is to investigate if N‐acetyl cystein contributes to the diagnostic accuracy of the Helicobacter pylori stool antigen test by increasing the sensitivity and specificity of the test.

The effect of Helicobacter pylori eradication on gastric juice and blood ammonia concentrations and on visual evoked potentials in cirrhotics.

The primary source of ammonia is the gut. Ammonia can also be generated by the urease activity of Helicobacter pylori in the gastric mucosa. The aim of this study was to investigate the effect of H. pylori eradication on blood and gastric juice ammonia levels and on visual evoked potential (VEP) recordings in cirrhotic patients.

Value of regional cerebral blood flow in the evaluation of chronic liver disease and subclinical hepatic encephalopathy

Aims:  Regional changes in cerebral blood flow in patients with chronic hepatitis, cirrhosis and subclinical hepatic encephalopathy were investigated in the present study using single photon emission computed tomography (SPECT).

A Case of Rapidly Progressive Pulmonary Aneurysm as a Rare Complication of Behçet's Syndrome A Case Report

One of the severe complications of Behçets syndrome is pulmonary arterial involvement. The authors report a patient with Behçets syndrome who had the complications of multiple pulmonary arterial aneurysms presenting with hemoptysis and right ventricular thrombus. He underwent emergency surgery because of failure of intensive immunotherapy and died 2 months after the surgery.

Is the Remarkable Contradiction between Histology and 14C Urea Breath Test in the Detection of Helicobacter pylori due to False-negative Histology or False-positive 14C Urea Breath Test?:

We assessed the diagnostic value of the 14C urea breath test (UBT) in the detection of Helicobacter pylori compared with histology and the rapid urease test (RUT). The study included 68 patients (22 men and 46 women) with dyspeptic symptoms. H. pylori status was evaluated by 14C UBT, RUT and histology. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were determined for 14C UBT and for RUT. Histology revealed dense yeast-like micro-organisms in the biopsy specimens in all patients with false-positive results by 14C UBT (n = 8), a significantly higher proportion than in patients with negative 14C UBT (five of 31). The low specificity of the H. pylori 14C UBT should not be neglected by accepting histology results as false-negative. Gastric mucosal colonization by yeast-like micro-organisms with urease activity can account for the high frequency of false-positive results for 14C UBT.

Seropositivity against Helicobacter pylori CagA in Turkish gastric cancer patients.

Background Increased prevalence of CagA in gastric cancer has been reported; yet, other reports suggest that the cagA gene is not associated with gastric cancer. Goals To evaluate the frequency of CagA seropositivity in Turkish patients with gastric cancer. Study Thirty-two patients with gastric adenocarcinoma and 46 patients with nonulcer dyspepsia were examined for Helicobacter pylori status and for antibodies against CagA. Results H. pylori was positive in 56.3% of patients and in 71.7% of controls. CagA was positive in all patients in the study group, regardless of H. pylori positivity, and in 56.5% of the control group. CagA positivity in H. pylori–positive patients was significantly more frequent in patients with gastric cancer than in those with nonulcer dyspepsia (p < 0.001). As for H. pylori–negative patients in both groups, CagA positivity was also more frequent in gastric cancer patients (p < 0.001). Conclusion Testing for H. pylori antibodies without testing for antibodies against CagA will miss patients with either recent or previous infection, which may be a cause of missing the relationship between H. pylori and gastric cancer. The authors think that testing for CagA in patients with dyspepsia can reveal which patients should be followed up for the risk of developing gastric cancer.