A comparison of the femur heads histomorphometrically regarding trabecular bone properties in the patients with osteoporosis and osteoarthritis.

The purpose was to compare the bone samples histomorphometrically regarding trabecular bone properties in the patients with osteoarthritis (OA) and osteoporosis (OP). Femoral head specimens were obtained from 18 patients with OA and 17 patients with femoral neck fracture due to OP during hip arthroplasty. Histomorphometric analyses were performed by soft ware program (Carl Zeiss) to measure trabecular area (Tb.a, mm(3)), trabecular thickness (Tb.th, µm) and trabecular separation (Tb.s, µm). In the results, Tb.a and Tb.th values were significantly lower (p < 0.05), Tb.s was higher in the patients with OP (p < 0.05). Bone metabolism parameters were different between the groups (p < 0.05). All histomorphometric parameters were highly correlated with the BMDs (p < 0.01). This study showed inverse relation between OA and OP regarding trabecular bone properties, BMD and bone turnover metabolism markers. The strong relations between results suggest that either BMDs or bone turnover markers can be used for prescience of the fractures.

Association between Toll-like receptors 4 and 2 gene polymorphisms with chronic allograft nephropathy in Turkish children.

Toll-like receptor (TLR) gene polymorphism is known to impair intracellular signaling pathways following adaptive immune responses. Our aim was to investigate the distribution of TLR4 and TLR2 gene polymorphisms among pediatric renal transplantation patients in relation to chronic allograft nephropathy (CAN). In addition to 115 healthy controls, we included 69 renal recipients, 19 of whom were identified as CAN by biopsy scored according to the Banff criteria. Polymorphisms at TLR4 Asp299Gly and/or Thr399Ile were present in 11.6% of renal transplant recipients. None of these subjects was identified in cosegregation with the Thr399Ile allele, whereas three had an isolated Asp299Gly and five had an isolated Thr399Ile. Neither renal recipients nor healthy controls were homozygous for both Asp299Gly and Thr399Ile polymorphisms. However, TLR4 Thr399Ile polymorphism and Ile allele was greater among CAN (-) versus CAN (+) recipients (P > .05). The frequency of TLR2 mutant type Gln allele was significantly higher in recipients than among healthy controls (P < .0001). However, the Gln allele frequency was similar between CAN (+) and CAN (-) patients. The results of present study may be speculated to show TLR4 and TLR2 gene polymorphisms as protective factors from CAN development due to impaired immune responses.

The role of fcgamma receptor gene polymorphism in pediatric renal transplant rejections.

The aim of the study reported herein was to determine whether panel-reactive antibody (PRA) and FcgammaR gene polymorphism act in the same way on acute rejection (AR) and chronic rejection (CR) in children who have undergone renal transplantation. The study evaluated 56 children who underwent transplantation and 115 healthy subjects. AR was observed in 13 cases; CR was observed in 7 patients. The assessment for FcgammaR of the groups in which AR was present showed statistical significance only for the FcgammaIIA genotype. There was no statistical significance for either the FcgammaIIIA or FcgammaIIIB genotypes. Assessment of the FcgammaIIA, IIIA, and IIIB genotypes of the groups in whom CR was present did not show statistical significance. As a result, the prediction of graft survival among transplant recipients is possible using molecular biology. The results of our study showed that individuals of the FcgammaRIIA genotype seemed to have a poorer prognosis similar to some autoimmune diseases. These individuals constitute a risk group for AR. If other studies are conducted with more patients to demonstrate the relationship of other FcgammaRs to rejection, the resultant predictive knowledge about the value of genotypes may lead to improved outcomes following renal transplantation.

A late-onset Epstein-Barr virus-related lymphoma completely remitted in a child with renal allograft.

Lymphomas are frequently encountered malignancies following renal transplantations. A 17-year-old boy was found to have lymphoma 1.5 years after a the first cadaveric transplantation performed due to reflux nephropathy. Polyclonal anti-thymocyte globulin (induction) with prednisolone (PRD), azathioprine (AZT), and tacrolimus (Tac) regimen had been given after the transplantation. A hypoechoic mass (25 mm) was detected in the upper pole of the allograft by renal Doppler ultrasound performed due to graft dysfunction with a high basal serum creatinine (Cr) (2.2 mg/dL). The renal biopsy revealed a large B-cell lymphoma with CD20 staining in the medulla. The serum displayed a positive Epstein-Barr virus (EBV), immunoglobulin (Ig)G, negative IgM with negative DNA-polymerase chain reaction. However, the biopsy was positive for EBV-LMA. The viral status at the time of transplant was unknown. After withdrawing AZT and Tac therapies, a chemoimmunotherapeutic regimen consisting of PRD, cyclophosphamide, and anti-CD20 monoclonal antibody was administered twice. The patient excreted the necrosed tumor particles over a 2-month interval with hydronephrotic colic attacks. The basal Cr improved at 6 months (to 1.4 mg/dL). A low dose of Tac (0.5 mg/d) was added to PRD. The patient has remained in complete remission for 2.5 years with a well-functioning renal allograft. Although this case was a late-onset lymphoma, the patient displayed a picture like excreting stones from the allograft and remitted completely. This case illustrates that localization of a tumor may play a more important role than the elapsed time from transplant in the diagnosis in EBV-related posttransplant lymphoproliferative disease.

Evaluation of growth hormone secretion after completion of therapy.

BACKGROUND: Growth hormone (GH) reserve in young adults previously diagnosed as having GH insufficiency, who were treated with human (h)GH replacement in childhood needs confirmation in adulthood. METHODS: Nine patients (seven males, two females; two empty cella, one hypoplasia of the hypophysis and six with idiopathic GH deficiency) diagnosed as having GH insufficiency by the insulin tolerance test (ITT) and dopamine stimulation test in childhood (mean age 12.8+/-2.6 years) were retested at completion of linear growth (mean age 21.0+/-3.0 years), 4.6+/-1.6 years after discontinuation of hGH therapy. RESULTS: At the initial diagnosis, seven had complete and two had partial GH deficiency. At diagnosis, the mean peak GH response to ITT and dopamine was 4.8+/-4.08 and 3.4+/-2.9 mU/L, respectively. At retesting, the mean GH response to ITT and dopamine stimulation was 3.5+/-2.5 and 3.3+/-3.1 mU/L, respectively (P=0.91 and 0.96, respectively). During hGH therapy, mean height velocity increased from 3.5+/-1.9 cm/year at diagnosis to 9.9+/-3.64 cm/year during the first year (P=0.002). One of nine children diagnosed as having GH insufficiency who was treated with hGH replacement had normal growth hormone secretion at completion of linear growth. CONCLUSIONS: All GH-insufficient children should be retested after completion of their hGH treatment and linear growth to identify those who are truly GH insufficient and who may benefit from GH therapy in adulthood.

Platelet-activating factor levels in term and preterm human milk.

It is well known that necrotizing enterocolitis (NEC) is less frequent in newborns being fed human breast milk. Since recent studies indicated that platelet-activating factor (PAF) plays an important role in pathogenesis of NEC, this study was conducted to investigate the PAF levels in human milk. Colostrum and mature human milk (samples obtained in the third week) of three groups of mothers were investigated. The first group had given birth within less than 32 weeks, the second between 33-37 weeks and the third group after 38 weeks of gestation. The PAF levels in colostrum of all three groups were similar (0.95 +/- 0.57, 1.05 +/- 0.52 and 1.19 +/- 0.64 ng/ml, respectively). Mature human milk in groups I and II had similar PAF levels (1.16 +/- 0.54 and 1.21 +/- 0.60 ng/ml, respectively), however, mature human milk in group III had a significantly higher PAF concentration (2.04 +/- 0.59 ng/ml) than both groups' levels. However, this phenomenon by itself does not explain the protective effect of human milk against NEC.