Yusuf Yazgan

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.

Accidental Oral Poisoning Caused by Rdx (Cyclonite): A Report of 5 Cases

The explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.

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.

Gallbladder and gastric motility in patients with idiopathic slow-transit constipation.

Objective Idiopathic slow-transit constipation (STC) has been suggested to be a pangastrointestinal motility disorder. We investigated scintigraphically whether motility in the gallbladder and stomach was impaired in slow-transit constipation. Methods Twenty-four patients with STC were studied. Colon transit time, gallbladder motility, and solid-phase gastric emptying were measured by scintigraphy. Results Gallbladder dysmotility was observed in 8 of 18 (44.4%) patients. Mean gallbladder ejection fraction was 41.6 ± 13.6% (range, 16.3–67.0%). Gastric emptying was delayed in 9 of 18 (50%) patients. Mean solid-phase gastric half-emptying time was 75 minutes. STC may be associated with impaired function of other gastrointestinal organs. Approximately half of patients with STC presented gallbladder or gastric dysmotility. Conclusion STC may not be a pure colonic abnormality; it may be a component of a pangastrointestinal tract motility disorder involving several organs.

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.