Life threatening chylothorax in a patient with congenital thrombophilia: case report.

We reported here a case of bilateral chylothorax as a result of widespread thrombi formation in a patient who was heterozygote for factor V leiden gene mutation and who had antithrombin III deficiency. We performed bilateral chest tubes, thrombolytic and oral anticoagulant therapy. The patient responded to the therapy. She has been in follow up without symptoms for 18 months.

Mitochondrial neurogastrointestinal encephalomyopathy.

Mitochondrial neurogastrointestinal encephalomyopathy is an autosomal recessive disease characterized by progressive ophthalmoplegia, peripheral neuropathy, mitochondrial abnormalities and gastrointestinal involvement. We describe a 19-year-old male having chronic intestinal pseudoobstruction associated with ophthalmoplegia and proximal muscle weakness. The clinical and radiologic features suggested the diagnosis of mitochondrial neurogastrointestinal encephalomyopathy. Mitochondrial genetic defects should be considered in the differential diagnosis of unexplained chronic gastrointestinal symptoms accompanied by neurological findings, especially in families where there is more than one individual with the same kind of symptoms.

The use of tissue polypeptide specific antigen as a marker in liver diseases.

BACKGROUND/AIMS: Tissue polypeptide specific antigen was first defined by Bjorklund in 1957 and is the specific M3 epitope of tissue polypeptide antigen. It is increased in malignant as well as in some benign diseases. The level of tissue polypeptide specific antigen in serum is related mostly with proliferation capacity rather than with tumor mass and cell necrosis. The aim of this study was to evaluate the levels of tissue polypeptide specific antigen and other tumor markers in patients with liver cirrhosis, chronic active hepatitis and hepatoma to determine if tissue polypeptide specific antigen is superior to other tumor markers in hepatoma patients. METHODS: Thirty-seven patients and 20 controls were included in the study. The patients were divided into three subgroups as cirrhosis, hepatoma and chronic active hepatitis. The levels of tissue polypeptide specific antigen, carcinoembryonic antigen, CA19-9, alpha-fetoprotein and transaminases were determined in all patients. RESULTS: Tissue polypeptide specific antigen levels were significantly higher in all patients than in the control group (p<0.005) According to Kruskal-Wallis test with regard to subgroups, the differences in mean values of tissue polypeptide specific antigen and alpha-fetoprotein were highly significant (p: 0.0001 for both). There was a low correlation between tissue polypeptide specific antigen and alpha-fetoprotein in the cirrhotic and hepatoma groups, but these were significantly correlated in the chronic active hepatitis group. The correlation coefficient between tissue polypeptide specific antigen and transaminases in all patients was low. CONCLUSIONS: Our data suggest that tissue polypeptide specific antigen is efficient in determining primary hepatoma patients and also that this marker is specific for proliferation of cells.

Cancer antigen 125 levels in patients with ascites.

BACKGROUND/AIMS: Cancer antigen 125 is a glycoprotein of 220 kDA molecular weight, that is released from coelomic epithelium during embryonic development. It has a low specificity, and high levels have been shown in many benign and malignant diseases. High correlation was detected between its level and ascites, especially in cirrhotic patients. In this study, we aimed to evaluate cancer antigen 125 levels in patients with ascites and determine the relationship between these levels and the amount of ascites. METHODS: Fifty-eight patients (25 men, 33 women, mean age 54.34 years) with ascites, hospitalized in our clinic, were included in the study. The patients with ovarian cancer were not included. For all patients, physical examination and abdominal USG were done and blood samples for routine screening and cancer antigen 125 were obtained and studied on the same day. RESULTS: Mean cancer antigen 125 levels in all patients were higher than normal. The highest levels were detected in patients with massive ascites and cirrhosis. With regard to diagnosis, the levels of cancer antigen 125 between groups were insignificant. According to USG results, there was a weakly positive but important correlation between groups. Although no correlation was present between cancer antigen 125 and ALT levels, a weak but positive correlation was present with AST levels. CONCLUSION: Our study showed that a correlation is present between cancer antigen 125 levels and the presence and amount of ascites. We also suggest that if cancer antigen 125 levels are above normal, the presence of ascites not detected by physical examination should be kept in mind.

Hypereosinophilic syndrome: case report.

Hypereosinophilic syndrome is a spectrum of disorders characterized by marked eosinophilia of no identifiable cause and by organ dysfunction. In 1999, a patient with marked weight loss, eosinophilia and a hypodense lesion in the right lobe of the liver was diagnosed as hypereosinophilic syndrome by fine needle aspiration biopsy and bone marrow aspiration biopsy. Echocardiography and thoracal HRCT was found to be normal. The patient was prescribed 30 mg prednisolone daily with the dose being tapered gradually. At the end of treatment, computerized tomography was normal but ultrasonography showed a 1mm x 3mm lesion. Liver scintigraphy was then performed in order to determine the activity of the lesion and was found to be normal. The lesion was therefore thought to be from a previous infection.