Ischemia-Modified Albumin Levels in Children with Chronic Liver Disease

BACKGROUND/AIMS: Ischemia-modified albumin (IMA) levels have been shown to correlate with the severity of liver failure in adults. However, the role of IMA levels has not been evaluated in children with chronic liver disease (CLD). We analyzed the clinical significance of IMA levels in children with CLD. METHODS: Thirty-three children with CLD and 33 healthy children were included in the study. Blood was collected to analyze biochemical parameters, oxidant status, and IMA. Liver biopsies were re-evaluated for liver fibrosis; severe fibrosis (SF) was defined as fibrosis stage > or =4. RESULTS: The IMA and and IMA to albumin ratios (IMARs) were significantly higher in children with CLD than in those without (IMA: 0.545+/-0.095 vs 0.481+/-0.062, p=0.003; IMAR: 0.152+/-0.046 vs 0.126+/-0.018, p=0.04). The IMAR was positively correlated with the pediatric end-stage liver disease score (p=0.03, r=0.503) and fibrosis score (p=0.021, r=0.400). Patients with SF had higher IMARs compared to patients with mild fibrosis (0.181+/-0.056 vs 0.134+/-0.025, p=0.003). The area under the receiver operation curve (AUROC) for predicting SF was 0.78 (p=0.006). Using a cutoff ratio value of 0.140, the sensitivity and specificity were 84% and 70%, respectively. The AUROC for predicting the need for liver transplantation and/or death was 0.82 (p=0.013). With a cutoff value of 0.156, the sensitivity and specificity was 83% and 82%, respectively. Kaplan-Meier analysis revealed increased morbidity and/or mortality in the group with an IMAR>0.156 (50% vs 4.3%, p=0.005). CONCLUSIONS: IMARs have been shown to provide important clues in predicting the fibrosis stage of the disease and determining the outcome in children with CLD.

Morphologic alterations and immunohistochemical analysis of alpha-fetoprotein and CD34 in chorionic villi of anembryonic pregnancy

To investigate the morphology of chorionic villi using light and electron microscopy, especially the expression of alpha-fetoprotein [AFP] in trophoblastic cells and the process of maturation and margination vasculogenesis proper using CD34 immunohistochemistry in tissues from the first trimester of pregnancy loss due to anembryonic pregnancy in comparison with embryonic pregnancy. The study consisted of 2 groups: 9 patients with anembryonic pregnancies and 9 patients with embryonic pregnancies between 6 and 10 weeks of gestational age registered at the Department of Gynecology and Obstetrics, University Hospital of Karadeniz Technical University, Turkey, from March 2003 to December 2004. We examined the chorionic villi using light and electron microscopy. For immunohistochemical staining, we used AFP and CD34. Microscopically, pathologic changes were shown in syncytiotrophoblast cells of anembryonic pregnancies and AFP was strongly expressed by villous trophoblastic cells compared to embryonic pregnancies. We determined the CD34 positivity in both groups. In anembryonic pregnancies, vascular elements were much fewer in number compared with embryonic pregnancies [p<0.001] and were located in the formed of hemangioblastic cords. Placental vasculogenesis is a basic feature in all types of pregnancy and a relationship exists between trophoblast cells and vessels in the chorionic villi with the potential to influence each other's functions. Defective chorionic villus vascularization is associated with embryonic death. This study may support the hypothesis, as suggested by previous studies, that anembryonic pregnancy results from early embryonic death and subsequent reabsorption rather than from the nondevelopment of an embryo

Evaluation of a new rapid lateral flow chromatography test for the diagnosis of helicobacter pylori

The rapid, simple and non-invasive diagnosis of Helicobacter pylori [H. pylori] infection is important in implementing chemotherapy in appropriate manner, and in assessing persistent H. pylori infection after eradication therapy. The ImmunoCard STAT! HpSA kit [Meridian Bioscience, Europe] is a lateral flow chromatography test which utilizes a monoclonal anti-H. pylori antibody. In this study, we investigated the usefulness of the ImmunoCard STAT! HpSA test before and after eradication therapy on patients referred to undergo upper gastrointestinal endoscopy. Sixty-five consecutive patients who were referred to undergo upper gastrointestinal endoscopy at the Department of Gastroenterology, Karadeniz Technical University Medical School, Turkey between February and August 2005 were included in this study. The ImmunoCard STAT! HpSA was compared with 4 invasive tests [histology, gram staining, rapid urease test, and culture]. The reference method was defined as positive when 2 of the 4 invasive tests were positive. A negative H. pylori status was considered when all 4 tests present concordant negative results. Overall, the ImmunoCard STAT! HpSA test had 77.8% sensitivity, 79.3% specificity, 82.4% positive predictive value [PPV] and 74.2% negative predictive value [NPV] in all patients. With regard to pre-treatment values, the sensitivity was 70.6%, specificity 70.6%, PPV 100% and NPV 100% while on post-treatment group the sensitivity was 84.2%, specificity 64.7%, PPV 72.7% and NPV 78.6%. Our results indicate that the ImmunoCard STAT! HpSA test is a rapid, simple, and helpful procedure not only to determine H. pylori infection but also to assess the success of eradication therapy

Correlation of E - cadherin expression with clinicopathological parameters in breast carcinoma

To investigate the correlation between the E-cadherin [E-CD] expression and clinicopathological parameters including tumor grade, patient age, tumor size, necrosis, peritumoral lymphovascular invasion and lymph node status in breast carcinomas. The specimens were surgically obtained from 51 female patients with breast carcinoma between 1997 and 2001 in Karadeniz Technical University Medicine Faculty Farabi Hospital, Trabzon, Turkey. Histologic grading was according to the Bloom and Richardson methods. Tumors were classified as grade I [well differentiated], grade II [moderately differentiated] and grade III [poorly differentiated]. Necrosis was graded as [-], [+], [++] and [+++].Grade 1 breast carcinomas [n=17] showed greater immunoreactivity than grade 2 [n= 22] and grade 3 [n=12] carcinomas. None of the infiltrating lobular carcinomas expressed E-CD. Statistically, significant difference has been noticed between E-CD expression and the histological grade. In contrast, no association were found between E-CD expression and metastatic potential, tumor size, tumor necrosis and patients' age. Results in the present report suggest that E-CD expression in breast carcinoma is more related to histological type and differentiation grade than with metastatic potential, tumor size, tumor necrosis and patients' age