Mean Level In Patients Research Articles

PARAMETERS OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION IN PATIENTS WITH HYPERTENSION DISEASE WITH CONCOMITANT TYPE 2 DIABETES MELLITUS

Objective: To conduct analyzes of the peculiarities of left ventricular (LV) diastolic function in patients with hypertension disease with concomitant T2DM and without it before and after complex treatment with the inclusion of Eplerenone 50 mg per day and Trimetazidine 80 mg per day. Design and method: The study examined 25 patients with HT and DM in a subcompensated state, with an HbA1c level of 7.6±0.34% (main group) and 25 patients with HT stage II (HbA1c level of 5.01±0.13%), without T2DM aged 35 to 65 years, who were being treated at the clinic of the GI “L.T. Malaya Therapy National Institute of the NAMS of Ukraine”. The control group consisted of 20 healthy individuals (HbA1c level of 4.68±0.49%). Results: The data in Table 1 suggest that in patients with HT and HT with comorbid T2DM, the mean kinetics of diastolic flow of the fibrous ring was significantly lower in comparison with the control group. While the e`mean level in patients with T2DM and HT was significantly lower in comparison with patients with HT. Thus, the findings indicate that aggregate hemodynamic and metabolic alterations adversely affect the kinetic capabilities of the myocardium. Moreover, the lowest rates of the myocardial diastolic relaxation rate were probably found in patients with HT with T2DM. The latter proves that the comorbidity of these negative factors significantly reduces the functional capacity of the myocardium. Conclusions:

Prediction value of creatine kinase level in conservative treated unruptured tubal ectopic pregnancies

Objectives: An ectopic pregnancy (EP) occurs when a fertilized ovum implants outside the endometrial cavity. We investigated the creatine kinase (CK) enzyme in conservatively treated EP to determine the resolution time and predict cases that may progress to surgical intervention. Methods: We include 43 patients with stable vital signs at recruitment. All participants were examined by using transvaginal ultrasound (TVUS). Beta human chorionic gonadotropin (β-hCG) and creatine kinase (CK) levels were also measured. In cases diagnosed with EP, intramuscular methotrexate (MTX) at a dose of 50 mg / m2 was administered and monitored with β-hCG titers. Follow-up continued until β-hCG titer became negative, or surgery became mandatory due to acute abdominal pain. Results: The mean β-hCG Level in the presence of an adnexal mass was statistically significantly higher than the mean level in patients in whom TVUS failed to define a mass. The mean β-hCG level in the surgical exploration group of patients was significantly higher than in those who did not require surgery. At a cut-off of 6486 mIU/mL, β-hCG could predict the emergence of acute abdomen with a sensitivity of 75% and a specificity of 94.3%. We examined CK level to contribute the test's specificity, but we found no difference among cases with and without surgical exploration. Conclusions: In patients treated conservatively for EP, CK levels at the outset neither predict an acute abdomen to emerge nor shed light on the resolution period in patients who respond to medical therapy.

Metabolic mediators determine the association of antinuclear antibody subtypes with specific clinical symptoms in systemic sclerosis

PurposeThe aim of this study was to investigate the possible link between different types of systemic sclerosis-specific antinuclear antibodies, adipokines and endothelial molecules which were recently found to have a pathogenic significance in systemic sclerosis. Materials/methodsSerum concentration of adiponectin, resistin, leptin, endothelin-1, fractalkine and galectin-3 were determined in the sera of patients with systemic sclerosis (n ​= ​100) and healthy controls (n ​= ​20) using ELISA. ResultsThe following associations between antinuclear antibodies and increased serum concentrations were identified: anticentromere antibodies with endothelin-1 (p ​< ​0.0001; mean level in patients 2.21 vs control group 1.31 ​pg/ml), anti-topoisomerase I antibodies with fractalkine (p ​< ​0.0001; 3.68 vs 1.68 ​ng/ml) and galectin-3 (p ​= ​0.0010, 6.39 vs 3.26 ​ng/ml). Anti-RNA polymerase III antibodies were associated with increased resistin (p ​< ​0.0001; 15.13 vs 8.54 ​ng/ml) and decreased adiponectin (p ​< ​0.0001; 2894 vs 8847 ​ng/ml). ConclusionIn systemic sclerosis metabolic and vascular factors may serve as mediators between immunological abnormalities and non-immune driven clinical symptoms.

Two Perforators Improve the Extent and Reliability of Paraumbilical Flaps for Upper Limb Reconstruction

BACKGROUNDSelf-management programs on needs of burn patients are still essential. So this study determined the effect of self-management training on anxiety and comfort of burn patients who were candidate for skin grafting.METHODSIn a continuous sampling method in Shahid Motahari Burn Center affiliated to Iran University of Medical Sciences, 80 burn patients candidate for skin grafting were divided into equal groups of intervention and control. Educational intervention was undertaken in the form of booklet during two sessions before and after skin grafting. Visual comfort scale questionnaire and Spiel Berger state-trait anxiety inventory were completed by patients before training and one month after intervention. RESULTSThere was a significant difference between the frequency of comfort level in both groups before and after the intervention. The level of comfort in the intervention group increased more than control group. The mean level of patients’ anxiety showed a significant difference between groups and scores in intervention group were significantly more than control group.CONCLUSIONAttention and control of anxiety and comfort in burn patients are one of the essential elements of their care. It can be suggested that self-management training can reduce anxiety and increase burn patients’ comfort.

Unconjugated bilirubin and acute psychosis: a five years retrospective observational and controlled study in patients with schizophrenia, schizoaffective and bipolar disorders

Introduction: Unconjugated bilirubin (UCB) high levels have been correlated with schizophrenia spectrum disorders.Methods: We searched for correlation between UCB mean levels, duration of psychiatric admission, and diagnosis in 255 individuals, including 56 healthy controls and 199 acute patients (namely 44 with schizophrenia, 99 with schizoaffective disorder and 56 with bipolar disorder).Results: We found a statistically significant difference between UCB mean levels of patients with schizophrenia versus patients with schizoaffective (0.41 mg/dL vs. 0.34 mg/dL; p < .03) and bipolar disorders (0,41 mg/dL vs. 0.29mg/dL; p < .0001). We also found a statistically significant difference between UCB mean levels of patients with schizoaffective disorder and bipolar disorder (0.34 mg/dL vs. 0.28; p < .04). We also found a significant difference (p < .001) between mean admission duration of schizophrenia (29 days) versus bipolar patients (16 days). Although in a non-significant manner, the schizoaffective group got a mean admission duration value (22 days) right in between the schizophrenia and the bipolar patients.Conclusions: Our results deserve further research to access the role UCB may have in the physiopathology of acute patients with schizophrenia/schizoaffective/bipolar spectrum disorders.KeypointsUnconjugated Bilirubin (UCB) high levels are correlated with acute psychosis.UCB high levels are correlated with duration of psychiatric admission.UCB mean levels of schizophrenic patients are higher than schizoaffective patients.UCB mean levels of schizoaffective patients are higher than bipolar patients.

Myopathy in Patients Taking Atorvastatin: A Pilot Study.

Aim:This study aims to investigate the prevalence and risk factors of statin-induced myopathy.Subjects and Methods:A total of 200 patients aged ≥ 40 years and taking atorvastatin 10 mg/day or more for at least 2 weeks were recruited in the study. A detailed history of participants and anthropometry of study participants was recorded, and features of myopathy were explained. Biochemical investigations along with thyroid stimulating hormone (TSH) and Vitamin D were done in all patients.Results:Mean age of study population was 54.81 ± 9.10 years. Sixty-five percent (65.5%) of atorvastatin users had coronary heart disease, 62.5% were hypertensive, 38% had diabetes. Thirty-five percent (35.5%) patients were taking 10 mg/day atorvastatin, 45% were taking 20 mg/day, and 19.5% were taking 40 mg/day. The overall frequency of myopathy among statin users was 7.5% which was significantly higher with increasing dose of atorvastatin (1.4% in 10 mg/day group, 10% in 20 mg/day group, and 12.8% in 40 mg/day, P < 0.05). The frequency of atorvastatin-related myopathy was higher in females 8.65% compared to 6.25% in males. Serum TSH levels in patients with myopathy were 4.05 ± 7.76 μIU/ml while in those without myopathy were 3.13 ± 2.88 μIU/ml (P = 0.649). Serum 25-hydroxy Vitamin D levels were measured in 66 patients randomly. Mean levels in patients with myopathy were 15.98 ± 12.94 ng/ml and without myopathy were 10.20 ± 5.64 ng/ml (P = 0.285).Conclusion:The present study demonstrates that a significantly higher number of patients taking atorvastatin develop myopathy in real life clinical condition. The frequency of myopathy increases with increase in atorvastatin dose.

Correlation between serum uric acid, nitric oxide, ferrtin and HbA1c levels in type II diabetic patients

Objectives: To estimate fasting plasma glucose (FPG), serum ferritin, HbA1c, uric acid and serum nitric oxide levels in type 2 diabetes mellitus (T2DM) subjects and compare the parameters with healthy controls and also to assess the correlation analysis between the biochemical parameters in T2DM patients. Materials and Methods: A case control study is conducted with a total of 56 diagnosed T2DM subjects and 31 healthy controls. FPG, serum ferritin, HbA1c, uric acid and serum nitric oxide levels were measured in all individuals. Results: The mean levels (mean  SD) of FPG, serum ferritin, HbA1c, serum uric acid and serum nitric oxide in control group were 98.06±7.28, 84.6±36.8, 5.46±0.84, 4.72±1.41 and 39.0±4.7 respectively. Similarly, in T2DM patients mean levels of 179.5±53.2, 457.9±402.2, 9.49±1.90, 8.57±2.38 and 100.9±26.5 were obtained for respective parameters. In T2DM subjects, mean values of serum ferritin, HbA1c, uric acid and serum nitric oxide were found to be significantly increased (p

Qualitative and quantitative analysis of FBN1 mRNA from 16 patients with Marfan Syndrome

BackgroundPathogenic mutations in FBN1, encoding the glycoprotein, fibrillin-1, cause Marfan syndrome (MFS) and related connective tissue disorders. In the present study, qualitative and quantitative effects of 16 mutations, identified in FBN1 in MFS patients with systematically described phenotypes, were investigated in vitro.MethodsQualitative analysis was performed with reverse transcription-PCR (RT-PCR) and gel electrophoresis, and quantitative analysis to determine the FBN1 mRNA levels in fibroblasts from the 16 patients with MFS was performed with real-time PCR.ResultsQualitative analysis documented that the mutations c.4817-2delA and c.A4925G led to aberrant FBN1 mRNA splicing leading to in frame deletion of exon 39 and in exon 39, respectively. No difference in the mean FBN1 mRNA level was observed between the entire group of cases and controls, nor between the group of patients with missense mutations and controls. The mean expression levels associated with premature termination codon (PTC) and splice site mutations were significantly lower than the levels in patients with missense mutations. A high level of FBN1 mRNA in the patient with the missense mutation c.G2447T did not segregate with the mutation in three of his first degree relatives. No association was indicated between the FBN1 transcript level and specific phenotypic manifestations.ConclusionsAbnormal FBN1 transcripts were indicated in fibroblasts from patients with the splice site mutation c.4817-2delA and the missense mutation c.A4925G. While the mean FBN1 mRNA expression level in fibroblasts from patients with splice site and PTC mutations were lower than the mean level in patients with missense mutations and controls, inter-individual variability was high. The observation that high level of FBN1 mRNA in the patient with the missense mutation c.G2447T did not segregate with the mutation in the family suggests that variable expression of the normal FBN1 allele may contribute to explain the variability in FBN1 mRNA level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12881-015-0260-4) contains supplementary material, which is available to authorized users.

Association of Tuberculosis and Infections of Herpes Simplex, Varicella Zoster Viruses and Cytomegalovirus

To determine frequency of Herpes simplex (HSV), Varicella zoster viral (VZV) and Сytomegaloviral (CMV) coinfection with tuberculosis (TB) we examined 45 patients with pulmonary TB and 62 healthy donors, 25 of them were healthcare workers in tuberculosis hospital and the rest 37 had no previous contact with TB. None of the participants had vesicular rash of skin or mucosa. For diagnosis of herpes viral infection enzyme-linked immunosorbent assay for detection of HSV, VZV, CMV IgG in PBMC supernatants was performed. A significant increase in CMV (53.3%) and HSV (40%) infection in TB patients was observed comparing to healthy donors (p &lt; 0.05; 19.4 and 16.1% respectively). Frequency of VZV infection in TB patients (17.8%) and healthy donors (8.1%) differed statistically unsignificantly. Levels of specific IgG secretion in PBMC culture in both groups in case of VZV and CMV infections didn’t differ, but in case of HSV coinfection in TB patients mean level of HSV IgG secretion (1.106 ± 0.297 OD) significantly exceeded mean level of HSV IgG in PBMC supernatants of healthy donors with asymptomatic HSV infection (0.285 ± 0.048 OD, р &lt; 0,05). The obtained data give evidence of an association of pulmonary TB and herpes viral infections. Influence of these coinfections on course and morbidity of TB requires further research.

High Level of Circulating Endothelial Progenitor Cells Positively Correlates with Serum Vascular Endothelial Growth Factor in Patients with Renal Cell Carcinoma

Although accumulated evidence indicates that circulating endothelial progenitor cells contribute to tumor neovascularization, to our knowledge the level of these cells and its correlation with serum vascular endothelial growth factor in patients with renal cell carcinoma have not been studied. We measured this level and investigated its clinical significance in patients with renal cell carcinoma. The level of circulating endothelial progenitor cells (percent of total peripheral blood mononuclear cells) was quantified by assaying the CD45(-)CD34(+)vascular endothelial growth factor receptor 2(+) cell phenotype in 53 patients with renal cell carcinoma, 33 with benign renal tumors and 40 healthy controls. Serum vascular endothelial growth factor was quantified. The mean circulating endothelial progenitor cell level in patients with renal cell carcinoma was 0.281%, significantly higher than in patients with benign renal tumors and healthy controls (0.073% and 0.076%, respectively, each p <0.001). Patients with stage III-IV renal cell carcinoma had a statistically higher level of these cells than those with stage I-II (0.339% vs 0.243%, p <0.001). The mean level in patients with renal cell carcinoma greater than 7 cm was 0.331%, significantly higher than in those with tumors 4 or less and 4 to 7 cm (0.225% and 0.231%, respectively, each p <0.001). Mean serum vascular endothelial growth factor in patients with renal cell carcinoma was higher than in patients with benign renal tumors and healthy controls (315.5 vs 34.6 and 26.9 pg/ml, respectively, each p <0.001). The preoperative circulating endothelial progenitor cell level positively correlated with serum vascular endothelial growth factor in patients with renal cell carcinoma (r = 0.710, p <0.001). Levels of these cells and of vascular endothelial growth factor significantly decreased postoperatively compared to preoperatively (0.081% vs 0.297% and 31.69 vs 310.70 pg/ml, respectively, each p <0.001). A high circulating endothelial progenitor cell level was found in patients with renal cell carcinoma, which positively correlated with serum vascular endothelial growth factor. Results support the potential use of circulating endothelial progenitor cells as a novel biomarker for renal cell carcinoma.

Kallikrein 6 as a Serum Prognostic Marker in Patients with Aneurysmal Subarachnoid Hemorrhage

BackgroundAneurysmal subarachnoid hemorrhage (aSAH) is a devastating condition that frequently causes death or significant disabilities. Blood tests to predict possible early complications could be very useful aids for therapy. The aim of this study was to analyze serum levels of kallikrein 6 (KLK6) in individuals with aSAH to determine the relevance of this protease with the outcome of these patients.Methodology/Principal FindingsA reference interval for KLK6 was established by using serum samples (n = 136) from an adult population. Additionally, serum samples (n = 326) from patients with aSAH (n = 13) were collected for 5 to 14 days, to study the concentration of KLK6 in this disease. The correlation between KLK6 and S100B, an existing brain damage biomarker, was analyzed in 8 of 13 patients. The reference interval for KLK6 was established to be 1.04 to 3.93 ng/mL. The mean levels in patients with aSAH within the first 56 hours ranged from 0.27 to 1.44 ng/mL, with lowest levels found in patients with worse outcome. There were significant differences between patients with good recovery or moderate disability (n = 8) and patients with severe disability or death (n = 5) (mean values of 1.03 ng/mL versus 0.47 ng/mL, respectively) (p<0.01). There was no significant correlation between KLK6 and S100B.Conclusions/SignificanceDecreased serum concentrations of KLK6 are found in patients with aSAH, with the lowest levels in patients who died.

Şizofrenide Bilişsel İşlevler Nüfus ve Klinik Özelliklerden Etkilenir mi?

ÖZETAmaç: Bu çalışmanın amacı şizofreni hastalarında bilişsel işlev bozukluklarının nüfus ve klinik özelliklerle ilişkisini incelemektir.Yöntem: Klinik olarak dengede olan ve zekâ geriliği bulunmayan 80 şizofreni hastası Wechsler Bellek Ölčeği Geliştirilmiş Formu (WBÖ-GF), Wisconsin Kart Eşleme Testi (WKET) ve Stroop Renk Sözcük Testi (SRST) ile değerlendirildi. Nöropsikolojik test sonuçları cins, yaş, meslek yaşamı, eğitim düzeyi, ailede psikotik bozukluk öyküsü, fiziksel şiddet davranşı, özkıyım girişimi, günlük sigara tüketimi, hastalığın başlangış yaşı, başlangıç şekli, süresi, tedavisiz geçen süre, hastanede yatış sayısı, toplam yatış günü, elektro konvulsif tedavi (EKT) uygulaması, hastalığın tipi ve hastalığın gidişi gibi nüfus ve klinik özellikler arasındaki ilişki MANCOVA analizi ile değerlendirildi.Bulgular: Hastaların zekâ puan ortalaması 86.7±10.8 idi. Nöropsikolojik test puanları ile nüfus ve klinik özellikler arasında anlamlı ilişki sadece eğitim düzeyinde (MANCOVA F=4.070, p=0.001) saptandı. Eğitimin bilişsel işlevsellik üzerinde etki gücü orta düzeyde idi (η2=0.372). Alt grup ileri analizde eğitim WBÖ-GF zihinsel kontrol, sayı dizisi, şekil belleği, sözel çağrışım çiftleri ve WKET başarılmış kategori sayısı ile ilişkili bulunurken SRST, WKET yineleyici hata sayısı ve WBÖ-GF mantıksal bellek ile ilişkili bulunmadı.Tartışma: Hastaların eğitim düzeyleri dışındaki nüfus ve klinik özellikleri ile bilişsel işlevleri arasında anlamlı bir ilişki saptanmamştır. Şizofreni hastalarında görülen bilişsel işlev bozulmalarının hastalık ortaya çıkmadan önce belirti vermeye başlayan temel bir bozukluğu yansıttığı söylenebilir.

076 In hospital short and long term prognostic value of homocysteine in patients with ST elevation myocardial infarction

Homocysteine has pro-thrombotic and pro-inflammatory properties, it is a risk factor for cardiovascular disease. The prognostic value of homocysteine in ST elevation myocardial infarction (STEMI) remains uncertain. Aim: This study evaluates the predictive role of homocysteine level on short and long term outcome in patients with STEMI. In this prospective cohort study, 186 consecutive patients (mean age 58.4 ± 12.6 years, 162 males, 65 diabetics) with STEMI were enrolled. Plasma total homocysteine levels were measured within 24h after admission. Inhospital complications: death, shock, left ventricular insufficiency or reinfarction were present in 46.8% of patients. Mean homocysteine levels in patients with and without early complications were 22.99 ± 19.01 and 17.93 ± 7.08 μmol/l, p = 0.018. The unadjusted hazard ratio of homocysteine level > 12μmol/l was 2.4, IC95% [1.04–5.65]. Cox proportional hazards model showed that plasma homocysteine was not an independent correlate of inhospital complications (Hazard ratio = 1.43, IC95% [0.37–5.53], p = 0.6). The mean follow-up period after discharge was 17.2 months [12 – 28.8 months], 43.2% of patients presented a late complication: death, cardiac insufficiency or myocardial infarction. Homocysteine wasn’t significantly correlated with late complications (mean levels in patients with and without late complications: 18.67 ± 5.99 and 20.19 ± 13.07μmol/l, p = 0.43). Homocysteine levels measured in the acute phase of STEMI are correlated only with early but not late outcome and it isn’t an independent predictor of inhospital major cardiovascular major complications.

A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder

Background In recent years, several studies showed increased rates of hyperglycaemia, diabetes, dyslipidemia, metabolic syndrome as well as cardiovascular disease in schizophrenic patients. The underlying mechanism, however, is poorly understood. Adiponectin is a recently identified adipocyte-derived protein, with low adiponectin levels being associated with metabolic abnormalities such as obesity, insulin resistance and type 2 diabetes. Methods Fasting adiponectin levels were assessed in a cross-sectional sample of 386 patients with schizophrenia or schizoaffective disorder. All patients were on monotherapy of second-generation antipsychotics (SGA) and underwent an extensive metabolic screening including an oral glucose tolerance test (OGTT). Results Adiponectin plasma levels were inversely correlated with BMI, and differed significantly between patients with normal weight, overweight or obesity ( p < 0.05). Patients who met criteria for the metabolic syndrome, according to adapted National Cholesterol Educational Program – Adult Treatment Panel criteria (NCEP-ATP III) (29.3%), had significantly lower adiponectin levels than patients not meeting metabolic syndrome criteria ( p < 0.0001). Patients without glucose abnormalities (78%) had significantly higher adiponectin levels than patients with diabetes (5.7%) ( p < 0.05). After controlling for components of metabolic syndrome and sex, antipsychotic medication independently influenced adiponectin levels ( p < 0.0001), with the lowest mean levels in patients on clozapine and olanzapine. Conclusions Adiponectin levels in schizophrenic patients mirror what is observed in the general population, with the lowest levels in the most metabolically comprised subjects. However, antipsychotic medication may also influence adiponectin regulation independently, a finding that should be confirmed in longitudinal studies.

P041 Thrombin generation among Sudanese essential hypertension patients

This is a descriptive, prospective analytical case -control based study conducted in Khartoum State Teaching Hospitals during the period of October 2003 to January 2008 to determine the thrombin generation among Sudanese hypertensive patients. Two hundred patients (200) and fifty nor mal controls (50) were studied. The results showed a significant correlation between hypertension and family history of patients and non significant correlation between family history of hypertension and the gender of the study group. Most hypertensive patients in the study group were presented with a duration range from 1 month up to 5 years us ing antihypertensive drugs as a treatment. The results showed a non significant difference between the mean level of patients and controls in prothrombin fragment 1+2 (F1+2) (p=0.925) and thrombin antithrombin complex (TAT) (p=0.867). Prothrombin fragment 1+2 level (p= 0.012) was significantly correlated to severity of hypertension (stage II), while thrombin antithrombin complex level did not show significant (p=0.124) correlation to the severity of the disease. Both circulating markers of thrombin generation (Prothrombin fragment 1+2 and thrombin antithrombin complex) were significantly (p=0.000) correlated to the duration of hypertension. The results obtained indicated that measurement of prothrombin fragment 1+2 could be of use in identifying a high-risk group of hypertensive patients who are likely to develop thrombotic events.

Nerve growth factor in serum is a marker of the stage of alcohol disease

Long-term alcohol abuse has deleterious effects on the peripheral and central nervous system. Nerve growth factor (NGF) is a pleiotropic neurotrophic protein involved in development, maintenance of function and regeneration of nerve cells. We examined patients in different stages of alcohol disease and measured their NGF serum concentrations based on the hypothesis that these reflect the state of disease. We examined 57 patients suffering from alcohol-dependence for more than 2 years (DSM IV) on day 8 of a qualified withdrawal, 18 patients with Korsakoff's syndrome and 40 healthy controls. In addition to clinical examination, careful history taking and a standard neuropsychological test battery, serum NGF concentrations were measured by a highly sensitive enzyme-immunoassay. Of the 57 patients 9 had suffered from severe withdrawal delirium in the past, other clinical parameters were alike. Cognitive test performance did not differ from the control group. Mean NGF levels of controls amounted to 42.1 pg/ml (S.D. 68.0); mean levels of patients with alcohol dependence were raised significantly to 401.5 pg/ml (S.D. 932.6) without delirium in the past and even further to 3292.5 pg/ml (S.D. 4879.6) with former withdrawal delirium. By contrast, patients with persistent amnestic disorder (Korsakoff's syndrome) showed values identical to the controls. NGF serum levels were significantly elevated in alcohol-dependent patients, more so in those with prior delirium. Their cognitive tests being normal, this possibly reflects the activity of NGF as an endogenous repair mechanism for damaged neurons. In accordance with this hypothesis, NGF values are “normal” in patients with persistent alcohol-related cognitive decline.

Telomerase activity in bilharzial bladder cancer: Prognostic implications

Background: Bladder cancer is a common malignancy in Egypt and other developing countries in which infection with Schistosoma haematobium is prevalent. Bladder cancer caused by bilharziasis has different clinical and biological characters than that observed in the western world. In this study, we used the TRAP technique to estimate telomerase activity in bilharzial bladder cancer specimens and we correlated the findings with other clinical and pathological findings. Patients and methods: Bladder cancer specimens were obtained from 57 patients who underwent radical cystectomy and pathological diagnosis was obtained in all patients. Tissue samples were frozen in liquid nitrogen and stored at −80°C. Telomerase activity by PCR-ELISA technique was measured using TRAP technique. Results: Our patient group included 45 males and 12 females with a median age of 49 years. The majority of our patients (35/57) have squamous histology and they have proven bilharzial history shown in the pathology specimens. Stage P3b was encountered in 29/57 patients whereas thirty-five patients have grade II tumors. The majority of our patients (41/57) were negative for pelvic nodes metastases. Telomerase activity was detected in 27/57 patients (47.4%). The mean level of telomerase was 0.85±0.77 in positive patients and 0.029±0.025 in negative patients. The expression of telomerase and its mean level in patients above age of 60, in males and in those with squamous pathology, higher grade of tumors or positive node was higher than those without but the difference did not reach statistical significance (P>0.05). Alternatively, expression was significantly higher in those with stages (P1–P3a) compared with P3b–P4a disease stages (66.6% vs. 37.1, P=0.03). Conclusion: Telomerase activity is increased in bilharzial bladder cancer although to a lesser degree than that reported for TCC in the western world, which could be explained, by different biological behavior or different assay methods. Further larger studies with more number of patients are still needed to determine its potential value for early detection and possible use as a therapeutic target.

MRI of microadenomas in patients with hyperprolactinaemia.

MRI is a sensitive tool for the investigation of pituitary microadenomas but cannot be used as a screening investigation. To establish a strategy for the use of MRI in patients with hyperprolactinaemia we investigated 74 women with serum prolactin levels above 52 ng/ml for the presence of microadenomas. We examined 55 premenopausal and 19 postmenopausal women, using a 1.5 T unit. We used T1-weighted spin-echo sequences, with coronal and sagittal images before and after intravenous gadolinium. We found microadenomas in 38 patients (51.3%), macroadenomas in 6 (8.1%) and an infundibular glioma in 1;29 patients had a normal pituitary gland (39.2%). The size of the adenomas was related to the prolactin level, and the mean level in patients with MRI evidence of adenomas was higher than in patients without microadenomas (155.72 +/- 131.01 ng/ml versus 110.14 +/- 80.86 ng/ml). The probability of the presence of an adenoma increased with rising serum prolactin levels. We suggest MRI in patients with prolactin levels more than 100 ng/ml. In patients on oestrogen therapy MRI should be performed with only slightly elevated prolactin levels. Evidence of a microadenoma should be considered in planning further therapy, especially concerning the use of hormone replacement therapy or of bromocriptine.

Clinical Study on the Serum Levels of Immunosuppressive Acidic Protein in Patients with Adult T-Cell Leukemia

Serum levels of immunosuppressive acidic protein (IAP) were measured in patients with adult T-cell leukemia (ATL) in order to clarify its significance in this disease. The mean levels in patients with both acute (854 +/- 404 micrograms/ml) and chronic ATL (439 +/- 103 micrograms/ml) were significantly higher than in sera of healthy controls (367 +/- 104 micrograms/ml). However, mean levels in patients with smoldering ATL, healthy T-cell lymphotropic virus type 1 (HTLV-1) carriers and healthy controls showed no differences. Levels in crisis in chronic and smoldering ATL were similar to those in patients with acute ATL. Serial measurements of serum IAP in a number of patients revealed that the levels reflected each patient's clinical course, suggesting a potential for use in evaluating the effects of chemotherapy.

1640 PROSTACYCLIN DEFICIENCY DOES NOT PLAY A PIVOTAL ROLE IN HEMOLYTIC UREMIC SYNDROME (HUS)

A decrease in the prostacyclin (PGI2) stimulating activity of plasma has been reported in children with HUS. Although no study has attempted to assess plasma PGI2 levels themselves, the presence of a decrease in the PGI2 stimulating activity has been equated with a deficiency of PGI2 in HUS. We have conducted an evaluation of plasma prostanoids (PGI2 and TXB2) in 5 children admitted to SUNY during an epidemic of HUS in the northeast and in 23 controls. We were unable to document a pivotal role for PGI2 deficiency in HUS. Using an RIA for plasma 6KPGF1α(the stable hydrolysis product of PGI2), patients with HUS demonstrated elevated 6KPGF1α levels of 1.05±0.3 (1SD) pmol/ml when compared to controls (0.41±0.13; p<0.001). Increased production of PGI2 in HUS was accompanied by a concomitant increase in plasma thromboxane. Compared to a plasma TXB2 level of 0.10±0.06 in controls, the mean level in patients with HUS was 0.33±0.09pmol/ml (p<0.001). When the ratio of plasma TXB2 to 6KPGF1α was evaluated as an index of proaggregatory and vasoconstrictor versus antiaggregatory and vasodilator influences, no difference was observed between controls (0.33±0.06) and HUS (0.33±0.08). Changes in prostanoid production in HUS appear to reflect vascular injury (T6KPGF1α) and concomitant platelet consumption (↑TXB2). A deficiency of PGI2 in HUS was an attractive hypothesis that explained the systemic hypertension and the observed thrombocytopenia. Our finding however does not support a role for prostacyclin deficiency, and underscores the heterogenousness of HUS.