Spontaneously developed paraplegia in a patient with Factor V Leiden mutation.

Factor V Leiden (FVL) mutation is the one-point mutation in G1691A in the tenth exon of the gene for Factor V, caused by the substitution of glutamine for arginine at codon 506. We present here a patient with a mutation of the Factor V gene and taking anticoagulant therapy, who became paraplegic following surgery for dural hematoma and spontaneous spinal intramedullary hematoma. His physical examination revealed T5 ASIA A, complete paraplegia. Our case is important in the literature, as being the first case with spinal intramedullary hematoma that developed due to anticoagulant use.

Tc-99m MDP bone scintigraphy in the evaluation of the joint damage in asymptomatic alpine ski racers.

AIM: To evaluate the role of 99m-technetium methylene diphosphonate (Tc-99m MDP) bone scintigraphy on the detection of joint damage in asymptomatic alpine ski racers. MATERIALS AND METHODS: This study included 20 male asymptomatic alpine ski racers (age range: 18-21 years). None of the skiers had a history of ski crashes. Bone scan findings of the racers were examined with Tc-99m MDP bone scintigraphy during the active racing season and the inactive training season. Planar anterior and posterior images of hip, knee, and ankle joints were obtained 4 h after intravenous injection of 20 mCi Tc-99m MDP. All images were interpreted visually by 2 experienced nuclear medicine physicians. Free regions of interest were drawn on hip, knee, and ankle joints, as well as background regions. Joint-to-background ratios were calculated for each joint, and the uptake ratios of both right and left joints during active ski season were compared to those during the inactive training period. RESULTS: Uptake ratios of the right and left hip, knee, and ankle joints were significantly higher during the active racing period than those calculated during the inactive period (P < 0.005). CONCLUSION: Bone scintigraphy may have an important role in detecting joint injuries of hip, knee, and ankle joints in asymptomatic alpine ski racers and can be used successfully when MRI is unavailable.

Relationship between primary nodal generalized osteoarthritis with tissue antigens HLA-A and HLA-B in the western Black Sea region of Turkey.

OBJECTIVE: To investigate the relationship between patients diagnosed with nodal generalized osteoarthritis (NGOA) and tissue antigens HLA-A and HLA-B in the Western Black Sea Region of Turkey. PATIENTS AND METHODS: Forty-six patients with NGOA (64.74±8.46) and 60 controls (62.32±6.8) were included in the study. Inclusion criteria were: (i) stage 2 and higher OA of the hand and knee based on the Kellgren-Lawrence classification, and (ii) stage 2 and higher lumbar disc degeneration according to Lawrence classification. Family histories were taken from patients. HLA-A and HLA-B were typed by PCR using sequence specific primer. RESULTS: The frequencies of HLA-A(*)02 and HLA-B(*)38 were 58.7% and 15.2%, respectively, in patients with NGOA, and there was a statistically significant relationship between the disease and HLA-A(*)02 and HLA-B(*)38. The relationship between positive family history and HLA-B(*)44 allele was also statistically significant. In the control group, the frequency of HLA-A(*)29 was 11.7% and it was statistically significant. CONCLUSION: To our knowledge this is the first study to demonstrate the epidemiologic association between HLA-A(*)02 and HLA-B(*)38 with NGOA in our population. We conclude that, HLA-B(*)44 positivity may be associated with familial NGOA and HLA-A(*)29 may be a preventive factor against NGOA.

Levels of antioxidant proteins and soluble intercellular adhesion molecule-1 in serum of patients with rheumatoid arthritis.

Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), ceruloplasmin (Cp), and transferrin (Tf) were measured in patients with rheumatoid arthritis (RA) and the correlations of these parameters with disease activity were investigated. Serum sICAM- 1 levels were determined by a sandwich enzyme-linked immunosorbant assay (ELISA) in serums from 42 patients with RA and 30 healthy controls. Erythrocyte sedimentation rate (ESR) was determined by the Westergren method and C-reactive protein (CRP), Cp, and Tf by nephelometric methods. Disease activity was assessed by standard criteria. Serum Tf levels were significantly diminished and serum levels of sICAM-1 and Cp were significantly increased in patients with RA, compared to healthy controls. Serum sICAM-1 levels showed negative correlation with serum Tf levels (r = -0.47, p < 0.01), and positive correlation with serum Cp levels (r = 0.49, p < 0.001). There was weak positive correlation between sICAM-1 levels and the Ritche articular index (RAI) scores (r = 0.32, p <0.05) and serum CRP levels (r = 0.44, p <0.01), but no significant correlations of sICAM-1 levels with ESR, patient's age, or duration of disease. There were no significant correlations between values of serum CRP, RAI score, or ESR with serum CP or Tf levels. This study indicates that serum sICAM-1, together with other parameters, is a useful and novel marker for evaluating the disease status and activity of patients with RA.

Sialic acid, intercellular adhesion molecule-1 and rheumatoid arthritis: a study on the erythrocyte membrane.

We measured serum levels of soluble intercellular adhesion molecule-1 and erythrocyte membrane sialic acid in patients with rheumatoid arthritis and studied their correlation with the disease activity. Serum soluble intercellular adhesion molecule-1 level was determined with sandwich ELISA and sialic acid level with the method of Shamberger in 42 patients with rheumatoid arthritis and in 30 healthy controls. Significantly lower erythrocyte membrane sialic acid and higher serum levels of soluble intercellular adhesion molecule-1 were found in patients with rheumatoid arthritis compared with healthy controls (p<0.001 for both). Significant negative correlation between soluble intercellular adhesion molecule-1 level and erythrocyte membrane sialic acid concentration (r=-0.49, p<0.001) and positive correlations between soluble intercellular adhesion molecule-1 level and Ritche Articular Index score and C-reactive protein (r=0.32, p<0.05; r=0.44, p<0.01, respectively) were observed. From these data we conclude that decreases in erythrocyte membrane sialic acid concentration and increases in soluble intercellular adhesion molecule-1, erythrocyte sedimentation rate and C-reactive protein levels are present in rheumatoid arthritis, and that the increased soluble intercellular adhesion molecule-1 in rheumatoid arthritis might be due to the decreased erythrocyte membrane sialic acid concentration. The levels of soluble intercellular adhesion molecule-1 may be a novel marker for the disease status and the activity of rheumatoid arthritis.