Acute pulmonary edema secondary to long-term use of oral ritodrine in a woman with a triplet pregnancy.

A 28-year-old primigravida who had taken oral ritodrine for 5 months to stop premature uterine contractions and was admitted in labor in the 33rd week of pregnancy developed acute pulmonary edema after cesarean section. Although parenteral ritodrine is the beta-adrenergic agent used most extensively to treat premature labor, only 1 case of pulmonary edema associated with long-term use of oral ritodrine had been reported so far. The present report presents for the first time computed tomographic findings of acute pulmonary edema secondary to tocolytic therapy.

Clinical and subclinical inflammation in patients with familial Mediterranean fever and in heterozygous carriers of MEFV mutations.

OBJECTIVE: To prospectively monitor inflammatory activity over a prolonged period in a cohort of Turkish patients with FMF, their healthy relatives and healthy controls and to relate this to their MEFV genotypes. METHODS: 43 patients with FMF and 75 of their asymptomatic relatives underwent fortnightly assessments and venesection for measurement of CRP and SAA over 5 months. 50 unrelated healthy population matched controls were also studied. MEFV genotyping was performed on all participants and comparisons were made between the different groups. RESULTS: Paired MEFV mutations were detected in 84% of FMF patients and single mutations in 12%. Substantial acute phase reactivity was seen among the patients with FMF during attacks (median SAA 693 mg/l, CRP 115 mg/l). Between attacks there was also some inflammatory activity (median SAA 6 mg/l, CRP 4 mg/l). Among healthy controls 16% were heterozygotes for MEFV mutations and 4% had two mutations. As expected there was a substantial carrier rate among healthy relatives with mutations detected in almost 92%. Asymptomatic MEFV heterozygotes had elevated acute phase proteins compared to wild type subjects. CONCLUSION: Substantial sub-clinical inflammation occurs widely and over prolonged periods in patients with FMF, indicating that the relatively infrequent clinically overt attacks represent the 'tip of the iceberg' in this disorder. Both basal and peak acute phase protein concentrations were greater in MEFV heterozygotes than in wild-type controls, regardless of mutation demonstrating a 'pro-inflammatory' phenotype among FMF carriers. Upregulation of the acute phase response among carriers of FMF may augment their innate host response and contribute to better resistance to infection.

Levels of interleukin-6 (IL-6) and its soluble receptor (sIL-6R) in familial Mediterranean fever (FMF) patients and their first degree relatives.

OBJECTIVE: Familial Mediterranean Fever (FMF) is a hereditary disease characterized by recurrent inflammatory attacks. A subclinical inflammation may persist in periods between the attacks and heterozygotes may have higher than normal levels of acute phase proteins. We investigated the levels of interleukin-6 (IL-6) and its soluble receptor (sIL-6R) in FMF patients and their obligatory carrier relatives. METHODS: Serum levels of IL-6 and sIL-6R were measured during acute attacks (n = 18) and in attack-free FMF patients (n = 26), obligatory carriers of FMF (n = 17) and normal controls (n = 11). RESULTS: The median levels of IL-6 were significantly higher (45.71 pg/ mL, p = 0.001) during acute attacks of FMF only, and were normal (0.01 pg/ mL) in the other groups studied. There was no statistically significant difference in the median sIL-6R values between any of the groups (p = 0.22). CONCLUSION: IL-6 was extremely elevated during FMF attacks but could not detect hypothetical "subclinical" inflammation during attack-free intervals or in the heterozygote relatives of patients. Serum levels of sIL-6R were comparable in all four groups.