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Saglam B, Kalyon H, Ozbalak M, Ornek S, Keske S, Tabak L, Cakar N, Zeren H, Aytekin S, Bolukbasi Y, Ferhanoglu B. Bortezomib induced pulmonary toxicity: a case report and review of the literature. Am J Blood Res 2020; 10:407-415. [PMID: 33489450 PMCID: PMC7811899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/22/2020] [Indexed: 06/12/2023]
Abstract
Bortezomib is widely used in the treatment of Multiple Myeloma. While the most common side effects are neurological and gastrointestinal related complications, severe pulmonary problems are rarely described. The present case is a 72-year old male with multiple myeloma, who received Lenalidomide, Bortezomib, and Dexamethasone (RVD) combination regimen. He underwent 30 Gy palliative radiotherapy to the thoracic 5-9 and lumbar L1-3 vertebra due to pain and fracture risk. During the third cycle, he was admitted to hospital with dyspnea and dizziness. The thoracic CT revealed bilateral pleural effusions, a diffuse reticular pattern on the parenchyma, and ground-glass opacities that were compatible with drug-induced lung injury. The microbiological and molecular analysis excluded infectious disease, and lung biopsy confirmed the diagnosis of Bortezomib Lung Injury. The time from the first dose of Bortezomib to the lung injury was 57 days, and it was five days from the last dose of Bortezomib. His symptoms were refractory to IV steroids and supportive care. Our patient was lost despite steroids and intensive care support. Even Bortezomib induced lung injury is a rare adverse effect, based on high mortality rate, we would like to emphasize the clinical importance of this clinical scenario in light of the published literature and our presented case.
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Affiliation(s)
- Burcin Saglam
- Department of Internal Medicine, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Hakan Kalyon
- Department of Hematology, American HospitalIstanbul, Turkey
| | - Murat Ozbalak
- Division of Hematology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul UniversityIstanbul, Turkey
| | - Serdar Ornek
- Department of Hematology, American HospitalIstanbul, Turkey
| | - Siran Keske
- Department of Infectious Diseases and Clinical Microbiology, American HospitalIstanbul, Turkey
| | - Levent Tabak
- Department of Respiratory Medicine, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Nahit Cakar
- Department of Anesthesiology and Reanimation, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Handan Zeren
- Department of Pathology, School of Medicine, Acıbadem UniversityIstanbul, Turkey
| | - Saide Aytekin
- Department of Cardiology, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, School of Medicine, Koç UniversityIstanbul, Turkey
| | - Burhan Ferhanoglu
- Department of Hematology, School of Medicine, Koç UniversityIstanbul, Turkey
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Keske Ş, Tekin S, Sait B, İrkören P, Kapmaz M, Çimen C, Uğur S, Çelebi İ, Bakır VO, Palaoğlu E, Şentürk E, Çağlayan B, Çakar N, Tabak L, Ergönül Ö. Appropriate use of tocilizumab in COVID-19 infection. Int J Infect Dis 2020; 99:338-343. [PMID: 32726724 PMCID: PMC7382959 DOI: 10.1016/j.ijid.2020.07.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This study aimed to describe the effectiveness and optimum use of tocilizumab (TCZ) treatment by the support of clinical, laboratory and radiologic observations. METHODS All patients were followed up in the hospital with daily interleukin-6 (IL-6), C-reactive protein (CRP), ferritin, d-dimer, full blood count, and procalcitonin. Thoracic computed tomography (CT) was performed on admission, when oxygen support was necessary, and seven days after TCZ started. Disease course of the patients was grouped as severe or critical, according to their clinical, laboratory and radiologic evaluations. RESULTS Forty-three patients were included: 70% were male; the median age was 64 years (minimum-maximum: 27-94); and six (14%) patients died. The median duration of oxygen support before the onset of TCZ was shorter among the severe patient group than the critical patient group (1 vs. 4 days, p < 0.001). Three cases of 21 (14%) who received TCZ in the ward were transferred to ICU, and none of them died. The levels of IL-6, CRP, ferritin, d-dimer, and procalcitonin were significantly lower in the severe cases group than the critical cases group (p = 0.025, p = 0.002, p = 0.008, p = 0.002, and p = 0.001, respectively). Radiological improvement was observed in severe cases on the seventh day of TCZ. Secondary bacterial infection was detected in 41% of critical cases, but none of the severe ones. CONCLUSION Earlier use of TCZ in COVID-19 infection was beneficial for survival, length of hospitalization and duration of oxygen support. The recommendation for administration of TCZ was based on an increase in requirement of oxygen support, progression in thoracic CT, and elevation of inflammation markers, including IL-6, CRP, ferritin, and d-dimer, and decrease in % lymphocytes.
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Affiliation(s)
- Şiran Keske
- American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Süda Tekin
- Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Bilgin Sait
- American Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Pelin İrkören
- Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Mahir Kapmaz
- Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Cansu Çimen
- American Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Semra Uğur
- Koç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, Turkey
| | - İrfan Çelebi
- American Hospital, Department of Radiology and Beykent University School of Medicine, Turkey
| | - Veli Oğuzalp Bakır
- Koç University, College of Engineering, Department of Industrial Engineering, Istanbul, Turkey
| | - Erhan Palaoğlu
- American Hospital, Clinical Laboratory, Istanbul, Turkey
| | - Evren Şentürk
- Koç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, Turkey
| | - Benan Çağlayan
- Koç University, School of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Nahit Çakar
- Koç University, School of Medicine, Department Anesthesiology & Intensive Care Unit, Istanbul, Turkey
| | - Levent Tabak
- Koç University, School of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Önder Ergönül
- Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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Abstract
Unprecedented advances in genomics, data science, and biotechnology have ushered in a new era of health care in which interventions are increasingly tailored to individual patients. Precision-based approaches extend to oral health, which is essential to overall health. Harnessing the full potential of precision oral health will depend on research to more fully understand the factors that underlie health and contribute to disease-including the human genome, microbiome, epigenome, proteome, and others.
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Affiliation(s)
- L Tabak
- National Institutes of Health, Bethesda, MD, USA
| | - E Green
- National Human Genome Research Institute, Bethesda, MD, USA
| | - S Devaney
- All of Us Research Program, Bethesda, MD, USA
| | - M Somerman
- National Institute of Dental and Craniofacial Research, Bethesda, MD, USA
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Ozyigit LP, Aktas EC, Senbas ZA, Ozturk AB, Ozturk E, Ergonul MO, Tabak L, Ferhanoglu B, Cetiner M, Deniz G. The role of atopy in the pathogenesis of bleomycin pulmonary toxicity. Respir Med 2019; 155:1-5. [PMID: 31255902 DOI: 10.1016/j.rmed.2019.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Bleomycin pulmonary toxicity (BPT) is a potentially life-threatening consequence of bleomycin usage in patients. An overproduction of epithelium-derived cytokines, habitually linked to allergic inflammation, has been recently revealed in experimental models of BPT. METHODS We assessed retrospectively our cohort of patients with Hodgkin Lymphoma treated with bleomycin between 2014 and 2016 for their demographic, clinical features, including BPT development, atopy status and risk factors for BPT. Then they were invited for allergy testing and blood sample collection. The samples were stimulated with different stimuli (Bleomycin, IL-33, TSLP) for 24 h on cell culture. The culture supernatants were analysed for TGF-β, Galectin3, Arginin, Amphiregulin, Eotaxin, IFNγ, TNFα, IL1β, 4, 5, 6, 10, 13, 17, MIP-1α, and bleomycin hydrolase (BLH) levels. RESULTS The cohort consisted of 51 patients showed that atopy was the only significant risk factor for BPT occurrence (OR: 7.2, p = 0.007). Fourteen subjects were included for blood analysis. The analysis of supernatants at the unstimulated condition revealed that BLH and Amphiregulin were significantly lower in patients who had BPT than controls. The BLH cut-off that best identified a history of BPT was 175.31 (Sensitivity: 62.5%, specificity: 100%). Following the stimulation, BLH reduced compared to the unstimulated condition and the difference between groups remained significant (p < 0.05). CONCLUSION Our study is the first to report that low levels of bleomycin hydrolase in allergic individuals may be predisposing to a possible pathway of fibrosis.
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Affiliation(s)
- Leyla Pur Ozyigit
- Koç University, School of Medicine, Department of Allergy and Immunology, Istanbul, Turkey.
| | - Esin Cetin Aktas
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey
| | - Zarif Asucan Senbas
- Koç University, School of Medicine, Department of Allergy and Immunology, Istanbul, Turkey
| | - Ayse Bilge Ozturk
- Koç University Hospital, Department of Allergy and Immunology, Istanbul, Turkey
| | - Erman Ozturk
- Koç University Hospital, Department of Haematology, Istanbul, Turkey
| | - Mehmet Onder Ergonul
- Koç University, School of Medicine, Department of Infectious Diseases, Istanbul, Turkey
| | - Levent Tabak
- Koç University, School of Medicine, Department of Respiratory Medicine, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Koç University, School of Medicine, Department of Haematology, Istanbul, Turkey
| | - Mustafa Cetiner
- Koç University, School of Medicine, Department of Haematology, Istanbul, Turkey
| | - Gunnur Deniz
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Immunology, Istanbul, Turkey
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Öztürk AB, Özyiğit LP, Şener Ü, Özyıldırım A, İliaz S, Çağlayan B, Tabak L. Reporting Adverse Drug Reactions in a Tertiary Care Hospital in İstanbul. Turk Thorac J 2018; 19:237-239. [PMID: 30455998 PMCID: PMC6196898 DOI: 10.5152/turkthoracj.2018.18048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/10/2018] [Indexed: 09/29/2023]
Affiliation(s)
- Ayşe Bilge Öztürk
- Department of Allergy and Immunology, Koç University Hospital, İstanbul, Turkey
| | - Leyla Pur Özyiğit
- Department of Allergy and Immunology, Koç University Hospital, İstanbul, Turkey
| | - Ülker Şener
- American Hospital Pharmacy Officer, İstanbul, Turkey
| | - Aslı Özyıldırım
- Vehbi Koç Foundation Health Institutions, Pharmacy Director, İstanbul, Turkey
| | - Sinem İliaz
- Department of Pulmonology, Koç University Hospital, İstanbul, Turkey
| | - Benan Çağlayan
- Department of Pulmonology, Koç University Hospital, İstanbul, Turkey
| | - Levent Tabak
- Department of Pulmonology, Koç University Hospital, İstanbul, Turkey
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Kiyan E, Kilicaslan Z, Caglar E, Yilmazbayhan D, Tabak L, Gürgan M. An unusual radiographic finding in pulmonary parenchymal endometriosis: A case report. Acta Radiol 2016; 43:164-6. [PMID: 12010296 DOI: 10.1080/028418502127347682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Thoracic endometriosis is an uncommon disorder. In most cases, the diagnosis is based on history alone and radiographic findings depend on the menstrual cycle. CT findings include ill-defined or well-defined opacities, nodular lesions, cavities, cystic changes and bullous formation. We report a case of pulmonary parenchymal endometriosis with an unusual radiographic finding.
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Affiliation(s)
- E Kiyan
- Department of Respiratory Medicine, Faculty of Medicine, Istanbul University, Turkey
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Okumus G, Kiyan E, Arseven O, Tabak L, Bayrak EK, Unaltuna NE, Issever H. Platelet Glycoprotein Ia 807c/T and 873g/A Polymorphisms in Patients With Venous Thromboembolism. Clin Appl Thromb Hemost 2016; 13:101-3. [PMID: 17164499 DOI: 10.1177/1076029606296422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Two silent polymorphisms (807C/T and 873G/A) within glycoprotein Ia (GPIa) gene have been implicated in increased risk of developing thrombosis and myocardial infarction in affected individuals. The aim of this study was to investigate the GPIa gene polymorphism in patients with venous thromboembolism (VTE). A multiplexed allele specific-polymerase chain reaction (AS-PCR)–based method was used to determine the GPIa 807T/873A allele frequency in 77 patients with VTE and 106 healthy controls. The allelic frequency for 807T/873A was 33% in the patient group and 38% in the control group. The allelic frequency for 807C/873G was 66% in the patient group and 62% in the control group. The genotypic frequencies were 8% for 807TT/873AA, 42% for 807CC/GG, and 50% for 807CT/GA in the patient group. In the control group, the frequencies were 12% for 807TT/873AA, 35% for 807CC/873GG, and 52% for 807CT/873GA. As a result, the glycoprotein Ia 807C/T and 873G/A dimorphisms were not shown as risk factors for VTE.
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Affiliation(s)
- Gulfer Okumus
- Istanbul Medical Faculty, Department of Pulmonary Diseases, Istanbul University, Turkey.
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Acar Ö, Mut T, Sağlıcan Y, Sag AA, Falay O, Selcukbiricik F, Tabak L, Esen T. Isolated omental metastasis of renal cell carcinoma after extraperitoneal open partial nephrectomy: A case report. Int J Surg Case Rep 2016; 21:6-11. [PMID: 26874583 PMCID: PMC4802132 DOI: 10.1016/j.ijscr.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/03/2016] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Metachronous metastatic spread of clinically localized renal cell carcinoma (RCC) affects almost 1/3 of the patients. They occur most frequently in lung, liver, bone and brain. Isolated omental metastasis of RCC has not been reported so far. CASE PRESENTATION A 62-year-old patient previously diagnosed and treated due to pulmonary sarcoidosis has developed an omental metastatic lesion 13 years after having undergone open extraperitoneal partial nephrectomy for T1 clear-cell RCC. Constitutional symptoms and imaging findings that were attributed to the presence of a sarcomatoid paraneoplastic syndrome triggered by the development this metastatic focus complicated the diagnostic work-up. Biopsy of the [18F]-fluorodeoxyglucose (+) lesions confirmed the diagnosis of metastatic RCC and the patient was managed by the resection of the omental mass via near-total omentectomy followed by targeted therapy with a tyrosine kinase inhibitor. DISCUSSION Late recurrence of RCC has been reported to occur in 10-20% of the patients within 20 years. Therefore lifelong follow up of RCC has been advocated by some authors. Diffuse peritoneal metastases have been reported in certain RCC subtypes with adverse histopathological features. However, isolated omental metastasis without any sign of peritoneal involvement is an extremely rare condition. CONCLUSION To our knowledge, this is the first reported case of metachronously developed, isolated omental metastasis of an initially T1 clear-cell RCC. Constitutional symptoms, despite a long interval since nephrectomy, should raise the possibility of a paraneoplastic syndrome being associated with metastatic RCC. Morphological and molecular imaging studies together with histopathological documentation will be diagnostic.
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Affiliation(s)
- Ömer Acar
- Koc University, School of Medicine, Department of Urology, Istanbul, Turkey
| | - Tuna Mut
- VKF American Hospital, Department of Urology, Istanbul, Turkey.
| | - Yeşim Sağlıcan
- Acibadem University, School of Medicine, Department of Pathology, Istanbul, Turkey
| | - Alan Alper Sag
- Koc University, School of Medicine, Department of Radiology, Division of Interventional Radiology, Istanbul, Turkey
| | - Okan Falay
- Koc University, School of Medicine, Department of Nuclear Medicine and Molecular Imaging, Istanbul, Turkey
| | - Fatih Selcukbiricik
- Koc University, School of Medicine, Department of Internal Medicine, Division of Medical Oncology, Istanbul, Turkey
| | - Levent Tabak
- Koc University, School of Medicine, Department of Internal Medicine, Division of Pulmonary Medicine, Istanbul, Turkey
| | - Tarık Esen
- Koc University, School of Medicine, Department of Urology, Istanbul, Turkey; VKF American Hospital, Department of Urology, Istanbul, Turkey
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Biçer EN, Öztürk AB, Ozyigit LP, Erus S, Tanju S, Dilege Ş, Tabak L. A case of uncontrolled severe asthma patient with coexisting carcinoid tumor presenting as pneumomediastinum. J Asthma 2015; 52:1095-8. [PMID: 26291136 DOI: 10.3109/02770903.2015.1054402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Patients with inadequately controlled or uncontrolled asthma are at a greater risk of attacks for asthma requiring emergency room visits or hospital admissions. There is a significant correlation between the severity of the disease and the severity of exacerbations. Patients with poorly controlled asthma are at a higher risk for complications. CASE STUDY We present a 24-year-old aspirin-intolerant, uncontrolled asthma patient with the complication of pneumomediastinum. RESULTS Severe symptoms persisted after the resolution of the pneumomediastinum despite intense anti-inflammatory and anti-obstructive therapy. A bronchoscopy revealed an endobronchial lesion and she was diagnosed with a carcinoid tumor. CONCLUSION This case is an example of the importance of re-evaluating asthma patients who do not respond to standard medical treatment. Clinicians should be aware of the complications associated with asthma attacks such as pneumomediastinum and the possibility of a differential diagnosis that worsen asthma symptoms such as a carcinoid tumor.
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Affiliation(s)
- Elif Nur Biçer
- a School of Medicine, Koç University , Istanbul , Turkey
| | - Ayse Bilge Öztürk
- b Department of Allergy and Immunology , Koç University Hospital , Istanbul , Turkey
| | - Leyla Pur Ozyigit
- c Department of Allergy and Immunology , School of Medicine, Koç University , Istanbul , Turkey
| | - Suat Erus
- d Department of Thoracic Surgery , Koç University Hospital , Istanbul , Turkey
| | | | | | - Levent Tabak
- f Department of Pulmonary Medicine , School of Medicine, Koç University , Istanbul , Turkey
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Yakar A, Yakar F, Sezer M, Bayram M, Erdoğan EB, Özkan D, Özçelik HK, Tabak L. Use of PET-CT for the assessment of treatment results in patients with sarcoidosis. Wien Klin Wochenschr 2014; 127:274-82. [DOI: 10.1007/s00508-014-0647-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 10/15/2014] [Indexed: 11/25/2022]
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Okumus G, Kiyan E, Bilge AK, Bingol Z, Comce F, Bolayir M, Kuran G, Kiyan A, Tabak L, Arseven O. Can Brain Natriuretic Peptide (BNP) be a Predictor for Pulmonary Arterial Hypertension? Turk Thorac J 2011. [DOI: 10.5152/ttd.2011.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Okumus G, Musellim B, Cetinkaya E, Turker H, Uzaslan E, Yenturk E, Uzun O, Saglam L, Kumbasar OO, Celik G, Annakkaya AN, Altiay G, Tabak L, Sakar A, Kiter G, Erturan S, Turktas H, Yalniz E, Akkoclu A, Ogus C, Dogan OT, Ozkan M, Aktogu S, Uzel I, Ongen G. Extrapulmonary involvement in patients with sarcoidosis in Turkey. Respirology 2011; 16:446-50. [PMID: 20946338 DOI: 10.1111/j.1440-1843.2010.01878.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. METHODS This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. RESULTS One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 ± 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). CONCLUSIONS Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.
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Affiliation(s)
- Gulfer Okumus
- Department of Pulmonary Diseases, Istanbul Medical Faculty, Istanbul University, Turkey.
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Kıter G, Müsellim B, Cetinkaya E, Türker H, Kunt Uzaslan AE, Yentürk E, Uzun O, Sağlam L, Özdemir Kumbasar Ö, Celik G, Okumuş G, Arbak PM, Altıay G, Tabak L, Sakar Coşkun A, Erturan S, Türktaş H, Yalnız E, Akkoçlu A, Öğüş C, Doğan ÖT, Özkan M, Özkan S, Uzel FI, Öngen G. Clinical presentations and diagnostic work-up in sarcoidosis: a series of Turkish cases (clinics and diagnosis of sarcoidosis). Tuberk Toraks 2011; 59:248-258. [PMID: 22087521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favour multimodality diagnosis.
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Affiliation(s)
- Göksel Kıter
- Department of Chest Diseases, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
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Ozcakir-Tomruk C, Tanyeri H, Tabak L, Dogan O. The Value of Labial Biopsy in the Differential Diagnosis of Sarcoidosis and Sjögren's Sydrome and Immunohistochemical Analysis. BIOTECHNOL BIOTEC EQ 2011. [DOI: 10.5504/bbeq.2011.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cımrın A, Albayrak S, Tabak L. [Position of occupational diseases in medical education in Turkey]. Tuberk Toraks 2010; 58:142-146. [PMID: 20865566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Currently, economical and socio-political changes seem to influence the point of view on occupational health all over the world. Duration of the occupational health education in medical schools decreases day by day and treatment based medical practice seems to be much more popular than preventive medicine activities. The aim of our study is to determine the quality and level of the occupational health education both during the education period and post post-graduation period of medical schools in Turkey. Two questionnaires on the occupational health education were sent to the medical schools of state universities. 65% of the medical schools answered the questionnaires. The average education time of the topic was 6.7 hours during pre-graduate period. Education was usually given by a faculty staff in respiratory medicine (73%) and in public health departments (52%). It was found that, only in six of 19 universities, the faculty staff members had a specific education on occupational health. In the post-graduate period, 15 respiratory medicine unite (62%) gives education on occupational health. As a conclusion, we can say that, there isn't a standardized and structured education program on occupational health/occupational diseases during the medical education during both the education period and post-graduation period of medical schools in Turkey. The duration and the quality of the present education programs seem to be insufficient.
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Affiliation(s)
- Arif Cımrın
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
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16
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Musellim B, Kumbasar O, Ongen G, Cetinkaya E, Turker H, Uzaslan E, Yenturk E, Uzun O, Saglam L, Celik G, Okumus G, Annakkaya A, Altiay G, Tabak L, Sakar A, Kiter G, Erturan S, Turktas H, Yalniz E, Akkoclu A, Ogus C, Dogan O, Ozkan M, Aktogu S, Uzel I. Epidemiological features of Turkish patients with sarcoidosis. Respir Med 2009; 103:907-12. [DOI: 10.1016/j.rmed.2008.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 11/02/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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Okumuş G, Engin Unver R, Kiyan E, Tabak L, Işsever H, Arseven O. Comparison of three clinical scoring methods in patients with pulmonary thromboembolism. Tuberk Toraks 2009; 57:163-168. [PMID: 19714507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The clinical diagnosis is not reliable in pulmonary thromboembolism (PTE) because the symptoms are mostly nonspecific. Different clinical prediction rules for PTE have been described recently. These rules are used to aid clinicians in assigning a pre-test probability to patients with clinical signs and symptoms of disease. The aim of this study was to assess the clinical probability of PTE using three different models (Wells, Wicki and modified Hyers scores) and to find their power to determine PTE probability. Clinical probabilities of patients with PTE were determined with Wells, Wicki and modified Hyers scores. Cramer's, contingency coefficient (CC), Spearman's rho, Kendal's tau-b and kappa tests were used for statistical analysis. The study included 248 patients (119 male, 129 female; mean age= 57 +/- 16.7 years). Although 61.3% of the patients were assigned high clinical probability with modified Hyers score, 56% and 50% of them were assigned moderate clinical probability with Wicki and Wells scores, respectively. The correlations of the clinical probabilities was low according to kappa correlation test and moderate according to the Cramer's, CC, Spearman's rho and Kendal's tau-b tests among these three scores. In conclusion, modified Hyers score showed higher percentage of high probability compared to Wells and Wicki scoring systems and the best correlation was found between the modified Hyers and Wells scores.
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Affiliation(s)
- Gülfer Okumuş
- Department of Chest Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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18
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Okumus G, Kiyan E, Arseven O, Tabak L, Diz-Kucukkaya R, Unlucerci Y, Abaci N, Unaltuna NE, Issever H. Hereditary Thrombophilic Risk Factors and Venous Thromboembolism in Istanbul, Turkey: The Role in Different Clinical Manifestations of Venous Thromboembolism. Clin Appl Thromb Hemost 2008; 14:168-73. [PMID: 17895505 DOI: 10.1177/1076029607305620] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to investigate the hereditary thrombophilic risk factors in patients with venous thromboembolism (VTE) and whether these risk factors play a different role in patients with isolated pulmonary embolism (PE) as compared with patients with deep vein thrombosis (DVT) and patients with PE + DVT. The protein C (PC), protein S, antithrombin activities, homocysteine levels, and factor V Leiden (FVL) G1691A and prothrombin G20210A mutations were evaluated in 191 patients with VTE and 191 controls. The prevalence of FVL and PC deficiency were higher in patients ( P = .003 and P = .02, respectively). There was no significant difference for the other risk factors. The combination of thrombophilic risk factors was significantly higher in patients with DVT + PE as compared with patients with isolated PE or DVT ( P = .04). In conclusion, the most important hereditary risk factors for VTE in this study were the FVL mutation and PC deficiency.
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Affiliation(s)
- Gulfer Okumus
- Department of Pulmonary Diseases, Istanbul Medical Faculty, Istanbul University, Capa-Istanbul, Turkey.
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19
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Esen BA, Kıyan E, Küçükkaya RD, Tabak L, Aktürk F, Arseven O, Okumuş G, İnanç M. Antiphospholipid Syndrome Presenting As Massive Pulmonary Embolism in a Patient With Sarcoidosis. Electron J Gen Med 2005. [DOI: 10.29333/ejgm/82338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Tabak L. Is smokeless tobacco less harmful than smoking? Anadolu Kardiyol Derg 2003; 3:236-7. [PMID: 12967891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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21
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Cuhadaroglu C, Erelel M, Tabak L, Kilicaslan Z. Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey. BMC Infect Dis 2002; 2:14. [PMID: 12144709 PMCID: PMC122064 DOI: 10.1186/1471-2334-2-14] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2002] [Accepted: 07/26/2002] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. A retrospective study of health records of HCWs in our hospital from 1991 to 2000. RESULTS The mean workforce of the hospital was 3359 + 33.2 between 1991 and 2000. There were 31 cases (15 male) meeting the diagnostic criteria for TB, comprising eight doctors, one nurse and 22 other health professionals. Mean incidence of TB was 96 per 100,000 for all HCWs (relative risk: 2.71), 79 per 100,000 for doctors (relative risk: 2.2), 14 per 100,000 for nurses and 121 per 100,000 (relative risk: 3.4) for other professionals. The mean incidence of TB in Turkey between 1991 and 2000 was 35.4 per 100,000. Incidence of TB was similar in the Departments of Chest Diseases and Clinical Medicine but there were no TB cases in the Basic Science and Managerial Departments. CONCLUSION HCWs in Turkey who work in clinics have an increased risk for TB. Post-graduate education and prevention programs reduce the risk of TB. Control programs to prevent nosocomial transmission of TB should be established in hospitals to reduce risk for HCWs.
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Affiliation(s)
- Caglar Cuhadaroglu
- Department of Chest Diseases, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Mustafa Erelel
- Department of Chest Diseases, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Levent Tabak
- Department of Chest Diseases, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Zeki Kilicaslan
- Department of Chest Diseases, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
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Kiyan E, Kilicaslan Z, Caglar E, Yilmazbayhan D, Tabak L, Gurgan M. An unusual radiographic finding in pulmonary parenchymal endometriosis. A case report. Acta Radiol 2002. [DOI: 10.1034/j.1600-0455.2002.430212.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tabak L, Ağirbaş E, Yilmazbayhan D, Tanyeri H, Güç U. The value of labial biopsy in the differentiation of sarcoidosis from tuberculosis. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18:191-5. [PMID: 11436540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Since the clinical features of sarcoidosis and tuberculosis may mimic each other, and that differentiation is not easy on clinical grounds, a histologic diagnosis may be mandatory in countries where the prevalence of tuberculosis is high or in populations with large numbers of immigrants from those countries. Previous studies have suggested the minor salivary gland biopsy as a useful method in the diagnosis of sarcoidosis. The present study was undertaken to evaluate the value of labial biopsy in the differentiation of sarcoidosis from tuberculosis in patients with enlarged hilar and paratracheal lymph nodes. METHODS Labial biopsy was performed in 50 consecutive patients with sarcoidosis, and in 35 consecutive patients with tuberculosis who had intrathoracic lympadenopathy. The files of all patients were reviewed for the clinical presentation, radiographic features, SACE levels, tuberculin skin test anergy, and the frequency of positive labial biopsy in each disease. RESULTS Noncaseating granulomas were present in labial biopsies obtained from 24 patients (48%) of 50 patients with sarcoidosis. Labial biopsies were positive in 4 of 6 patients who had an abnormality on eye examination and in 3 of 5 patients who had noncaseating granulomas on biopsy material from skin. In two of 4 patients who underwent mediastinoscopy, noncaseating granulomas were detected on labial biopsy. In contrast to the patients with sarcoidosis labial biopsies revealed normal minor salivary glands in all patients with tuberculosis. CONCLUSIONS Labial biopsy has a high discriminatory value as a diagnostic tool in the differentiation of sarcoidosis from tuberculosis. Although it has a rather lower diagnostic yield than transbronchial lung biopsy, labial biopsy should be considered as a first line approach prior to performing other more invasive procedures for the tissue confirmation of sarcoidosis.
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Affiliation(s)
- L Tabak
- University of Istanbul, Faculty of Medicine, Department of Pulmonary Medicine, Istanbul/Türkiye.
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24
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Yildiz A, Sever MS, Türkmen A, Ecder T, Beşişik F, Tabak L, Ece T, Kiliçarslan I, Ark E. Tuberculosis after renal transplantation: experience of one Turkish centre. Nephrol Dial Transplant 1998; 13:1872-5. [PMID: 9681753 DOI: 10.1093/ndt/13.7.1872] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In this study, renal transplant recipients with tuberculosis of different organs, were retrospectively analysed with respect to prevalence, outcome and drug toxicity. PATIENTS AND METHODS In 520 patients, 22 (4.2%) tuberculosis of various organs was diagnosed. The time interval between transplantation and diagnosis of tuberculosis was 44.4 +/- 33.5 (range 3-111) months. In 18 (82%) of the patients, tuberculosis was detected after the first year of transplantation. The most common form was pleuro/pulmonary tuberculosis (54%), and other localizations included jejunum, liver, bone, and urogenital tract. RESULTS Sixteen of the 22 patients responded favourably to the treatment and maintain excellent allograft function, whereas six patients (27.2%) died. Toxic hepatitis was seen in four (18%) patients, and one case was complicated with acute hepatocellular failure due to isoniazide (INH). However, of the 23 patients at risk of tuberculosis who had had INH prophylaxis for 1 year, neither tuberculosis, nor hepatotoxicity was observed. CONCLUSION Tuberculosis is a common infection of renal transplant recipients in developing countries. The peak incidence is after the first year of transplantation and mortality is considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of additive toxic effects of immunosuppressive drugs.
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Affiliation(s)
- A Yildiz
- Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Turkey
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Hoheisel GB, Tabak L, Teschler H, Erkan F, Kroegel C, Costabel U. Bronchoalveolar lavage cytology and immunocytology in pulmonary tuberculosis. Am J Respir Crit Care Med 1994; 149:460-3. [PMID: 8306046 DOI: 10.1164/ajrccm.149.2.8306046] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Limited data on the cellular and immunocytologic characteristics of bronchoalveolar lavage (BAL) fluid in pulmonary tuberculosis have been reported. We therefore studied 40 patients with active disease. BAL fluid differential cell counts and lymphocyte subsets were determined. The findings were compared with data from 47 patients with active sarcoidosis and 30 healthy control subjects. The proportion of lymphocytes was increased in both diseases (p < 0.001 versus control subjects) but with no difference compared to one another. The CD4/CD8 ratio was normal in 33 of 40 patients with pulmonary tuberculosis in contrast to sarcoidosis, with an increased ratio in 33 of 47 patients. HLA-DR+ T lymphocytes were significantly increased in both pulmonary tuberculosis and sarcoidosis (p < 0.05 versus control group). The proportion of CD57+ lymphocytes was normal in all study groups. We conclude that pulmonary tuberculosis and sarcoidosis are characterized by an increased percentage of lymphocytes in BAL fluid with a similar proportion of activated T cells. In contrast to active sarcoidosis, in which an elevated CD4/CD8 ratio is characteristic, in the majority of pulmonary tuberculosis patients the CD4/CD8 ratio is within the normal range.
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Affiliation(s)
- G B Hoheisel
- Department of Pneumology/Allergy, Ruhrlandklinik, Medical Faculty, Essen University, Germany
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Abstract
Adult lipid storage disorders with pulmonary involvement are rare and usually diagnosed at autopsy. We report a patient with splenomegaly and reticulonodular pattern on lung computed tomography. Bronchoalveolar lavage was performed and revealed the presence of lipid-containing foamy cells, with the demonstration of both periodic acid-Schiff (PAS) and scharlach red stain positive vacuoles in the cytoplasm of alveolar macrophages. The same cells were found in bone marrow biopsy. As in other rare disorders, bronchoalveolar lavage may be of diagnostic value in lipid storage disorders with pulmonary involvement.
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Affiliation(s)
- L Tabak
- Dept of Pulmonary Diseases, Faculty of Medicine, University of Istanbul, Turkey
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Erkan F, Baur X, Kiliçaslan Z, Tabak L, Arseven O, Erelel M, Jaeger D, Cavdar T. [Exogenous allergic alveolitis caused by mouldy hazel nut leaves]. Pneumologie 1992; 46:32-5. [PMID: 1546060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 62-year old farmer woman from the northeastern, very rainy part of Turkey has been collecting large amounts of green and brown involucral hazel-nut leaves for subsequent use as fuel. For the last 20 years she had been complaining of cough, respiratory distress and intermittent fever. In the course of years of continual antigen exposure she developed the clinical and x-ray signs of fibrosis of the lung. Bronchoalveolar lavage produced the typical cell pattern of chronic exogenous allergic alveolitis with predominant CD8 cells. Serum analysis yielded high titres of IgG antibodies against mould fungi partly obtained from hazel-nut husk cultures, as well as thermophilic actinomycetes.
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Affiliation(s)
- F Erkan
- Pneumologische Klinik, Medizinischen Fakultät Istanbul, Universität Istanbul
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Abstract
MDL 17,043, an inotropic and vasodilator drug, is believed to have beneficial effects in patients with heart failure. Its short- and long-term hemodynamic and cardiopulmonary effects were studied in 10 patients with New York Heart Association functional class III heart failure who were maintained on digitalis and diuretic drugs. Hemodynamics at baseline study and after 24 hours of oral therapy (four doses of 6 mg/kg) showed increased cardiac output (3.9 +/- 0.7 to 6.1 +/- 1.1 liters/min, p less than 0.05), increased stroke volume (42 +/- 12 to 60 +/- 15 ml, p less than 0.05), decreased systemic vascular resistance (1,564 +/- 326 to 1,009 +/- 296 dynes X s X cm-5, p less than 0.05) but no change in pulmonary capillary wedge pressure (31 +/- 6 to 25 +/- 13 mm Hg, p = NS). Only systemic vascular resistance and arteriovenous oxygen difference were significantly decreased during exercise. When restudied after 5 weeks of therapy, neither cardiac output nor stroke volume showed a sustained increase at rest or during exercise, and effects on systemic vascular resistance and arteriovenous oxygen difference were not sustained at exercise (p = NS). Peak oxygen uptake during exercise was 8.1 +/- 2.5 ml/kg per min at baseline and was not significantly increased either acutely (9.2 +/- 2.4 ml/kg per min, p = NS) or chronically (8.9 +/- 2.2 ml/kg per min, p = NS). Problems of increased ventricular arrhythmias and diarrhea were noted after therapy was begun.(ABSTRACT TRUNCATED AT 250 WORDS)
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Fine DH, Tabak L, Salkind A, Oshrain H. Studies in plaque pathogenicity. II. A technique for the specific detection of endotoxin in plaque samples using the limulus lysate assay. J Periodontal Res 1978; 13:127-33. [PMID: 148501 DOI: 10.1111/j.1600-0765.1978.tb00161.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fine DH, Tabak L, Oshrain H, Salkind A, Siegel K. Studies in plaque pathogenicity. I. Plaque collection and limulus lysate screening of adherent and loosely adherent plaque. J Periodontal Res 1978; 13:17-23. [PMID: 147328 DOI: 10.1111/j.1600-0765.1978.tb00150.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
During the active phase of chronic recurrent parotitis there is a marked elevation in the parotid concentration of lactoferrin (Lf), and iron-binding glycoprotein with antibacterial properties. The Lf concentration decreases during the recovery period, but still remains above normal levels. The changes of Lf in parotitis parallel recent findings in mastitis and pancreatitis. Elevations in Lf were also noted in five of six subjects with Sjögren's disease, but not in subjects with sarcoidosis, diabetes or "dry mouth" without sialographic changes. The source of the Lf has not been determined; it could arise in part from disrupting polymorphonuclear leucocytes and in part from epithelial cells that synthesize Lf in the salivary glands. Inflammatory stimulation of Lf synthesis would suggest a basic protective mechanism in exocrine glands and should be fully explored.
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Abstract
An immunoadsorbent method is described for the purification of antibody directed against gram negative bacteria. Two anion exchange materials were compared for their ability to immobilize whole cells of Veillonella alcalescens, a gram negative oral bacterium. Purified antibody preparations were applied to the columns and subsequently eluted with various combinations of desorbing buffers. The quantity of recovered antibody was measured and its activity assayed, using a microagglutination technique. The highest levels of protein and specific antibody activity were recovered from Dowex-1-acetate columns desorbed by a combination of borate buffer pH 10 and 3 M KSCN pH 6, followed by levels of specific antibody activity obtained from a DEAE cellulose column desorbed by glycine--HC1, PBH 2.3.
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