HLA-G levels in serum and plasma

HLA-G belongs to the non-classical HLA class-I family of genes presently designated as class-Ib genes. There are four membrane-bound (HLA-G1 to -G4) and three soluble forms (HLA-G5 to -G7) generated by alternative splicing of the primary transcript. HLA-G in the soluble form is found in the plasma, amniotic fluid, and cord blood of healthy individuals. Quantitative determination suggested that HLA-G levels are genetically controlled. While quantifying soluble HLA-G by ELISA, we observed that when plasma and serum levels were measured for the same individual, HLA-G plasma values were almost invariably higher than those from serum. Our results suggest that HLA-G is trapped and/or consumed during clot formation. The amount trapped within the clot is variable and inconsistent. To obtain values which reflect the true biological levels, it is therefore recommended that HLA-G should be determined in the plasma. If serum levels are determined, they should be compared with matched control sera. It should always be borne in mind that conclusions concerning sera levels might be erroneous, because the true plasma level of the protein can be significantly higher.

Evidence for blood chimerism in dizygotic spontaneous twin pregnancy discordant for Down syndrome

BACKGROUND

A monochorionic-diamniotic placenta (MCDAP) is rare in dizygotic (DZ) twinning. All reported cases have been documented in pregnancies achieved by the induction of ovulation alone or during the IVF cycle.

METHODS AND RESULTS

We report a spontaneous pregnancy in a 39-year-old patient with evidence of MCDAP in DZ twins, discordant for trisomy 21. The first and second-trimester sonographic scans indicated male twins with MCDAP. Amniocentesis, performed because of advanced maternal age, revealed a normal karyotype in one fetus, and trisomy 21 in the other. Molecular studies, performed in order to confirm the zygosity and chorionicity, demonstrated that the fetuses were DZ. In order to identity the affected twin, a detailed sonographic examination was repeated, but no abnormal findings associated with Down syndrome were demonstrated in any of the fetuses. Therefore, umbilical cord blood samples were obtained from both fetuses. Chromosomal analysis revealed in both fetuses two cell lines: a normal cell line of 46,XY and a 47,XY,+ 21 cell line, in 65 and 80% of the cells, respectively. This result was independently confirmed by both FISH and G-banding. DNA extracted from both cord blood samples demonstrated an admixture of two distinct genotypes in each sample.

CONCLUSIONS

We propose that this case represents a monochorionic-dizygotic twin pregnancy with blood chimerism. The most plausible mechanism underlying this phenomenon is placental fusion early in pregnancy, resulting in an architecturally single placenta originating from two distinct zygotes. The newly formed blood vessels created anastomoses between the DZ twins and allowed reciprocal blood chimerism between the normal and the trisomic twin.

Feto-feto-fetal transfusion syndrome in monozygotic monochorionic triamniotic triplets: vascular evaluation by a cast model

A unique cast model of the placenta in a rare case of feto-feto-fetal triplet transfusion syndrome (FFFTTS) allowed the demonstration of why the transfusion syndrome developed in one fetus and not in the other two in that single placenta. The vasculature anatomy of a monochorionic triamniotic triplet placenta with FFFTTS of three healthy infants (one donor, two recipients) born in the 35th week of gestation was cast by means of dental casting materials. After the cast hardened, the tissue was corroded, revealing the cast blood vessels. The diameters and lengths of the chorionic blood and intraplacental vessels of the cast placenta were measured with a digital caliper. The cast revealed two artery-artery (A-A) anastomoses on the chorionic plate between the two recipients and the donor. Seven artery-vein (A-V) deep anastomoses connected only the arteries of the donor and the veins of the two recipients. The blood vessel connections among the fetuses allowed the evaluation of a pathologic case with its own control in a single placenta. From the vascular appearance, we speculate that the A-A anastomoses between the two fetuses protected them from developing blood transfusions, but that the A-V anastomoses contributed to their development.

Common ancestral origin of pemphigus vulgaris in Jews and Spaniards: a study using microsatellite markers

Pemphigus is a group of autoimmune blistering diseases of the skin and mucous membranes. The association of pemphigus with human leukocyte antigen (HLA) is widely accepted. It was described in many ethnic groups and in most countries of the world. Studies showed that the associated HLA haplotype in Jewish pemphigus vulgaris (PV) patients is HLA-B38, DRB1*0402, and DQB1*0302; or HLA-B35, DRB1*0402, and DQB1*0302. Similar associations with class II genes were found in Spanish non-Jewish PV patients. As Jews lived in Spain for hundreds of years and many converted to Christianity, the presence of the same HLA haplotype in the Jewish and Spanish PV suggests that they may share the same founder. Microsatellite markers which span the entire major histocompatibility complex (MHC) locus were used as genetic probes. They were utilized to dissect the MHC region in the search for possible common haplotypes, besides HLA, which may provide an answer to this question. It was found that in both cohorts, in addition to HLA class II genes, there are probably genes in the class I region which are associated with PV. Alleles belonging to the associated markers were used to construct haplotypes and to estimate genetic distances. The distance between the two PV cohorts is relatively short, but the distance between the Jewish patients and the Jewish controls is greater compared to the distance between Spanish patients and Spanish controls. In both PV populations, the same microsatellite haplotypes in addition to a common class II haplotype were found, suggesting that both patient populations originated from the same genetic stock and, therefore, share the same ancestral disease gene.

Different phenotypic expression in monozygotic twins with Huntington disease

Monozygotic (MZ), 46-year-old, male twins, carrying the same Huntington disease (HD) mutation, presented with a different clinical course. In one of the twins, the disease process started at the age of 32 years with chorea, dysarthria, and a depressed mood. Over 14 years, the disease progressed to total functional dependence. The second twin presented at age 35 with gait disturbances. His behavior became aggressive with an obsessive pattern, whereas the motor features included hypokinesia, rigidity, gait unsteadiness, and dysarthria. This is the first report of genetic identity associated with different age of disease onset as well as a different motor and behavioral phenotype. Postzygotic events are a likely explanation for the observed differences of phenotype in these genetically identical twins.

NQO2 gene is associated with clozapine-induced agranulocytosis

Clozapine is a dibenzodiazepine neuroleptic with atypical pharmacological and clinical profiles. Treatment with this drug may be complicated with agranulocytosis (AGR). It is likely that defective oxidative mechanism may be the cause of AGR. A candidate gene, dihydronicotinamide riboside (NRH) quinone oxidoreductase 2 (NQO2), which is involved in detoxification of drugs, was selected. This gene has been mapped to the short arm of chromosome six. The gene was studied by single-strand conformation polymorphism analysis and direct sequencing in 98 schizophrenic patients that were treated with clozapine. Eighteen of these patients developed AGR. Ten polymorphisms in the coding regions, in intron 1, and in the promoter region were found, two of which were novel. Comparisons of the polymorphisms in the first intron in AGR patients and controls suggested that this site might be connected with AGR. Quantitative reverse transcriptase-polymerase chain reaction analysis showed that the level of NQO2 mRNA is low in AGR patients compared with the control group. Such a reduction in message suggests that the NQO2 gene may be involved in the development of clozapine-induced AGR.

Effect of stabilization splint therapy on pain during chewing in patients suffering from myofascial pain

Masticatory myofascial pain (MFP) condition is a musculoskeletal disorder that compromises the functional capacities of the masticatory system. As such, the incorporation of an intensive chewing test as a discriminatory exercise for the diagnosis of this condition and evaluation of treatment success has considerable potential. Various splint designs have been used successfully, which have posed a question of whether the therapeutic effect of the splint is a placebo or has some other curative properties. The purpose of this study was to evaluate the efficacy of the stabilization appliance to reduce signs and symptoms in MFP patients and to compare the pain experience during the chewing test between two groups of patients, with and without splints. Myofascial pain patients (n = 37) who reported exacerbation of pain in function participated in the study. Patients perfomed a 9-min chewing test, followed by 9-min rest and marked their pain intensity on a visual analogue scale every 3 min. Of the 37 patients, 21 received a stabilization flat occlusal splint for night use and 16 were equally monitored clinically without a splint. At the end of 8 weeks, a second clinical examination and chewing test were performed. Student's t-test was used to analyse differences between study groups. Analysis of variance and covariance (ancova) with repeated measures was applied to analyse the effect of treatment. Level of pain at baseline prior to the chewing test (P0) was introduced as a co-variant. At baseline both groups showed relatively high scores of pain intensity and did not show any significant differences among the collected variables. At the end of the experiment, the splint group had a statistically significant reduction in pain intensity, in mean muscle sensitivity to palpation and in the pain experience during the chewing test compared with no change in the controls. A stabilization splint has a therapeutic value beyond its placebo effects. Thus, it should be an integral part of the treatment modalities in MFP disorder patients. An intensive chewing test is an effective tool to evaluate the treatment modality efficacy in MFP patients.

Oral motor parafunctions among heavy drug addicts and their effects on signs and symptoms of temporomandibular disorders

AIMS

To investigate the prevalence of temporomandibular disorders (TMD), bruxism, and other oral habits among drug addicts compared to a normal, non-addicted, matched control population, and to assess the detrimental effect of long-term drug abuse on the parameters studied.

METHODS

Subjects included 55 drug-addicted patients (51 males and 4 females) randomly selected from long-term addicts using "hard" narcotics and attending a methadone maintenance center and a control group of 52 normal non-addicted individuals (48 males and 4 females) matched to the addicts for age, gender, and socioeconomic status. A clinical examination and a questionnaire were used. One examiner determined that all questions were correctly understood and answered, and a second examiner performed the clinical examinations and was unaware of the results of the questionnaire.

RESULTS

The addicted group had a high prevalence of orofacial motor behavior (bruxing, clenching) as well as signs and symptoms of TMD (morning headache, joint noises, joint and masticatory muscle tenderness to palpation, and tooth wear) compared to the controls. Active (voluntary) jaw opening was significantly smaller, although within an acceptable range when compared to the controls.

CONCLUSION

Long-term drug abuse detrimentally affects the stomatognathic system, as expressed in a high prevalence of oral motor behavior and signs and symptoms of TMD.

Prevalence of cystic fibrosis mutations in Israeli Jews

The aim of this study was to evaluate the screening policies of cystic fibrosis (CF) in the Jewish population. The prevalence of mutations that account for CF in Israel have been defined in the past by determining the frequency of CF mutations in affected individuals. This study is a population-based study and is, therefore, different from previous patient-based studies. We found that the CF mutations D1152H, W1089X, and 405 + IG-->A were present in some ethnic groups in which no CF patients carrying these mutations were reported. These facts necessitate a reevaluation of the screening policy regarding the ethnic groups in Israel. We studied 9,430 healthy Jewish Israeli individuals of 36 countries of origin. The prevalence of CF mutations was 1:19, 1:19, 1:28, and 1:42 for the Ashkenazi, Sephardi, North African, and Eastern Jews, respectively. CF mutations were identified in 374 (4.0%) individuals. These included 173 (46.3%) carriers of the W1282X mutation; 110 (29.4%) found to carry delF508; 23 (6.1%) who carried G542X; 22 (5.9%) who carried 3849 + 10Kb (C-->T; 20 (5.3%) who carried D1152H; 10 (2.7%) who carried N1303K; 11 (2.9%) who carried 405 + IG-->A; 4 (1.1%) who carried W1089X; and one (0.3%) who carried S549R. No carriers were detected for the 1717-1G-->A, G85E, and T360K mutations, which were tested for in 7,383, 1,558, and 41 individuals, respectively.

Identification of new mutations in Israeli patients with X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy (ALD) is a peroxisomal disorder characterized by impaired peroxisomal betaoxidation of very-long-chain fatty acids (VLCFAs). This is probably due to reduced activation of the VLCFAs and results in demyelination of the nervous system and adrenocortical insufficiency. The ALD gene is localized on Xq28, has 10 exons and encodes a protein of 745 amino acids with significant homology to the membrane peroxisomal protein PMP70. Characterizing the disease causing mutations is of importance in prenatal diagnosis because 12-20% of women who are obligatory carriers show false-negative results when tested for VLCFA in plasma. We have analyzed DNA from blood samples of 7 Jewish (5 Sephardi and 2 Ashkenazi) and 3 Arab Israeli families suffering from ALD. Five missense-type mutations were identified: R104H, Y174C, L229P, R401Q, and G512C. A single mutation, R464X, was nonsense, and two, Y171 frameshift and E471 frameshift, were frameshift. Interestingly, a single mutation was identified in three families of Moroccan Jewish descent, probably due to a founder effect.

Further experience with intravenous immunoglobulin in women with recurrent miscarriage and a poor prognosis

PROBLEM

Women with three or more unexplained miscarriages have a 60% chance of a subsequent live birth. Intravenous immunoglobulin (IVIG) has not been conclusively shown to improve this prognosis. This study assessed the effect of IVIG in patients expected to have a poor outcome if untreated, i.e. women with five or more abortions, who have aborted after paternal leukocyte immunization or who continue to abort despite expressing anti-paternal complement dependent antibody.

METHODS

Seventy-six women received IVIG in a dose of 400 mg/kg body weight, in one day (total 30-45 g) in the follicular phase of a cycle in which pregnancy was planned. A booster dose was administered when pregnancy was diagnosed. Their results were compared to an untreated control group of 74 women.

RESULTS

Thirty-five (49%) pregnancies in treated women have resulted in live births or passed their previous stages of abortion compared to 23 (31%) in control patients (P = 0.04).

CONCLUSIONS

These figures indicate that IVIG may prevent further miscarriages in this poor prognosis population. These figures are especially significant considering the doubt concerning the efficacy of IVIG in patients with three miscarriages and therefore a relatively good prognosis.

Analysis of the minimal amyloid-forming fragment of the islet amyloid polypeptide. An experimental support for the key role of the phenylalanine residue in amyloid formation

The development of type II diabetes was shown to be associated with the formation of amyloid fibrils consisted of the islet amyloid polypeptide (IAPP or amylin). Recently, a short functional hexapeptide fragment of IAPP (NH(2)-NFGAIL-COOH) was found to form fibrils that are very similar to those formed by the full-length polypeptide. To better understand the specific role of the residues that compose the fragment, we performed a systematic alanine scan of the IAPP "basic amyloidogenic units." Turbidity assay experiments demonstrated that the wild-type peptide and the Asn(1) --> Ala and Gly(3) --> Ala peptides had the highest rate of aggregate formation, whereas the Phe(2) --> Ala peptide did not form any detectable aggregates. Dynamic light-scattering experiments demonstrated that all peptides except the Phe(2) --> Ala form large multimeric structures. Electron microscopy and Congo red staining confirmed that the structures formed by the various peptides are indeed amyloid fibrils. Taken together, the results of our study provide clear experimental evidence for the key role of phenylalanine residue in amyloid formation by IAPP. In contrast, glycine, a residue that was suggested to facilitate amyloid formation in other systems, has only a minor role, if any, in this case. Our results are discussed in the context of the remarkable occurrence of aromatic residues in short functional fragments and potent inhibitors of amyloid-related polypeptides. We hypothesize that pi-pi interactions may play a significant role in the molecular recognition and self-assembly processes that lead to amyloid formation.

Cephalometric and polysomnographic analyses of functional magnetic system therapy in patients with obstructive sleep apnea

The therapeutic effect of a functional magnetic system on obstructive sleep apnea and the system's operating mechanism have not been examined. Two hypotheses are postulated: a functional magnetic system increases the size of the oral cavity airway passage, or it increases the pharyngeal space. Twenty-eight patients with mild-to-moderate obstructive sleep apnea were examined; 10 patients (9 men and 1 woman; aged, 50.5 +/- 2.6 years) met the study criteria. After baseline nocturnal polysomnography and daytime tiredness self-evaluation, a functional magnetic system was inserted. The functional magnetic system is a mandibular repositioning appliance that uses a pair of attractive magnets (Sm2Co17), placed opposite each other in the jaws, which results in an advancement-to-opening ratio of 1:2. After 8 weeks of functional magnetic system treatment, polysomnography, daytime tiredness, and nighttime snoring were evaluated, and cephalogram radiographs with and without the appliance were taken. It was found that the respiratory disturbance index decreased significantly; minimal oxygen saturation increased significantly, reaching a normal value; day time tiredness improved; snoring declined; the oral cavity anterior region increased significantly, and the pharyngeal airway passages did not change. Reduction in the respiratory disturbance index and enlargement of the anterior oral cavity area were highly and significantly correlated. In conclusion, the functional magnetic system is a reliable mandibular repositioning appliance that has no apparent adverse effects. A functional magnetic system operates by increasing the anterior region of the oral cavity, mainly vertically, with no change in the posterior oral cavity region and pharyngeal airway passages.

Breast augmentation with fresh-frozen homologous fat grafts

The purpose of this report is to present a patient who underwent breast augmentation with fresh-frozen fat homografts in Russia 10 years ago, despite the publication of major complications following this procedure.

Oral habits among adolescent girls and their association with symptoms of temporomandibular disorders

AIM

To evaluate the contribution of certain parafunctional activities to the presence of temporomandibular disorder (TMD) symptoms among teenage girls, with special emphasis to gum chewing and jaw play.

METHODS

A total of 323 girls, aged 15-16 years, were randomly selected from a religious junior high school. The girls responded to a questionnaire on oral habits and TMD symptoms.

RESULTS

Gum chewing was a very prevalent habit (62.4%), performed daily (mean chewing time 3.95 h day-1). Girls who chewed intensively (more than 4 h day-1) showed associations with pain in the ear area during function and at rest, as well as with joint noises. Jaw play, although reported by only 14.3%, was significantly associated with pain in the ear area during function and at rest, feeling of tiredness of the jaw while chewing, joint noises, catch and lock. All oral parafunctions, except chewing gum, were associated with jaw play and with each other.

CONCLUSIONS

Jaw play was the most detrimental habit in TMD; intensive gum chewing was a potentially contributing factor for joint noises and pain. Oral parafunctions (except chewing gum) were significantly associated between themselves and suggest a behavioural pattern of "jaw hyperactivity".

Topical application of capsaicin for the treatment of localized pain in the temporomandibular joint area

AIMS

To determine the effectiveness of topical capsaicin cream application on localized pain in the temporomandibular joint (TMJ) area.

METHODS

A randomized, double-blind, placebo-controlled study was conducted on 30 patients suffering from unilateral pain in the TMJ area. Patients were randomly divided into experimental and placebo groups; they were instructed to apply 0.025% capsaicin cream or its vehicle to the painful TMJ area 4 times daily for 4 weeks. Subjective parameters of present pain, most severe pain, effect of pain on daily activities, and pain relief were assessed each week on a visual analog scale. Muscle and joint sensitivity to palpation on the painful and contralateral joints and maximal mouth opening (assisted/passive and non-assisted/active) were examined weekly by the same experienced examiner.

RESULTS

Capsaicin cream produced no statistically significant influence on measured variables when compared to placebo. Both experimental and placebo groups showed statistically significant improvement in most variables during the experiment.

CONCLUSION

The factor of time had a major effect in the non-specific improvement of the parameters assessed. The placebo effect played an important role in the treatment of patients with pain in the TMJ area.

Splints and stress transmission to teeth: an in vitro experiment

OBJECTIVE

To determine the influence of hard and soft splints with two thicknesses on the stress transmission to the tooth supporting the splint and the opposite tooth.

METHODS

Continuous vertical forces up to 500N were applied to two opposite first molar phantom teeth using a universal loading machine. Deformation was detected by strain gauges attached to the cervical area of the buccal and lingual aspects of the lower tooth. Strain, as a function of force, was collected and the slope, defined as the compliance (in microS/N) of the system, was calculated.

RESULTS

The highest compliance was found with hard splints. When splints were constructed on the upper molar, the highest compressive compliance was registered on the buccal side (2.8 microS/N) and tension compliance on the lingual side (-0.35 microS/N). When constructed on the lower tooth, the opposite was found. Soft splints resulted in compression on both the buccal and lingual sides when adjusted to the upper or lower tooth. A higher compliance was found on the buccal side (1.26 microS/N), while on the lingual side, the values varied (0.48-0.78 microS/N).

CONCLUSIONS

Soft splints are more efficient in protecting teeth against the damage of bending forces although there is an increase of compression forces. The tooth opposing a hard splint is exposed to a higher risk of bending forces.

Hereditary juvenile-onset craniocervical predominant generalized dystonia with parkinsonism

OBJECTIVE

To report a unique hereditary, juvenile onset, craniocervical predominant, generalized dystonia and parkinsonism affecting four members of one family.

FAMILY DESCRIPTION

A father and three of his four daughters presented to us over the past 30 years with a similar picture of generalized dystonia, starting in the craniocervical region in the second or third decade of life. They later developed moderate parkinsonism, mainly manifesting bradykinesia, rigidity and abnormal postural reflexes. Biochemical and genetic tests excluded Wilson's disease, Huntington's disease and Oppenheim's dystonia.

CONCLUSION

This is a new type of familial dystonia-parkinsonism where the craniocervical dystonic symptoms are most prominent in the early stages while parkinsonism becomes the predominant problem later in life. A search for the genetic mutation in this family is underway.

Generalized joint laxity and its relation with oral habits and temporomandibular disorders in adolescent girls

A group of 248 girls, aged 15-16 years, were randomly selected and examined both clinically and by questionnaire with regard to the signs and symptoms of temporomandibular disorders (TMD), generalized joint laxity (GJL), range of mandibular opening, temporomandibular joint (TMJ) hypermobility and presence of oral parafunctions. The prevalence of GJL was 43% and that of TMJ hypermobility (TMJH) was 27.3%. A significant, albeit weak, correlation was found between the two. In the presence of joint click, both active and passive opening were significantly larger. When either muscle or joint sensitivity to palpation was present, the difference between the active and passive range of mouth opening increased significantly. The presence of reported clicks was negatively associated with GJL. This association was not valid in the presence of parafunction. Some of the signs and symptoms of TMD affected the range of mouth opening. In the presence of joint clicks, the mean active and passive mandibular opening were significantly larger. In the presence of joint and muscle sensitivity to palpation, the difference between passive and active mouth opening was larger. This was possibly because of the effect of pain on the full active range of opening, which was invalid in the registration of the passive mandibular opening. GJL, when present, did not seem to jeopardize the health of the stomatognathic system as expressed in the signs and symptoms of TMD. There was a negative association between GJL and the presence of reported joint clicks and catch. When a parafunction was present in addition to GJL, this association was invalid but not reversed, as has been previously reported.

A novel mutation in the HEXA gene specific to Tay-Sachs disease carriers of Jewish Iraqi origin

An increased frequency of carriers of 1:140, as defined by reduced hexosaminidase A (HexA) activity, was observed among Iraqi Jews participating in the Tay-Sachs disease (TSD) carrier detection program. Prior to this finding, TSD among Jews had been restricted to those of Eastern European (Ashkenazi) and Moroccan descent with carrier frequencies of 1:29 and 1:110 for Jews of Ashkenazi and Moroccan extraction, respectively. A general, pan-ethnic frequency of approximately 1:280 has been observed among other Jewish Israeli populations. Analysis of 48 DNA samples from Iraqi Jews suspected, by enzymatic assay, to be carriers revealed a total of five mutations, one of which was novel. In nine carriers (19%), a known mutation typical to either Ashkenazi or Moroccan Jews was identified. DeltaF304/ 305 was detected in four individuals, and + 1278TATC in three. G269S and R170Q each appeared in a single person. The new mutation, G749T, resulting in a substitution of glycine to valine at position 250 has been found in 19 of the DNA samples (40%). This mutation was not detected among 100 non-carrier, Iraqi Jews and 65 Ashkenazi enzymatically determined carriers. Aside from Ashkenazi and Moroccan Jews, a specific mutation in the HEXA gene has now also been identified in Jews of Iraqi descent.

Shared HLA antigens in couples with 5 or more, compared to 3 or 4 consecutive recurrent miscarriages

OBJECTIVE

Couples with consecutive recurrent miscarriages (CRM) are not generally believed to share more HLA antigens with their spouses than expected by chance. This paper attempted to determine the situation in patients with five or more miscarriages.

METHODS

The number of shared HLA class I and class II antigens, HLA phenotype, and the ability to mount an antibody response in a large cohort of 425 couples with CRM was assessed, according to whether the patient had three or four, or five or more miscarriages.

RESULTS

There was no significant difference in the frequency of shared HLA antigens in women with five or more miscarriages when compared to three or more miscarriages or control patients. No specific HLA antigen or phenotype was associated with CRM in male or female partners of either group. The number of shared antigens did not influence ability to develop anti paternal antibodies (APA). Moreover, HLA antigen sharing had no influence on the subsequent pregnancy after paternal leucocyte immunization.

CONCLUSION

Class I and Class II HLA antigens are not diagnostic for immunologically mediated abortion, do not predict the ability to mount an antibody response, or the outcome of a subsequent pregnancy.

Behçet's disease in Familial Mediterranean fever: characterization of the association between the two diseases

OBJECTIVES

Familial Mediterranean fever (FMF) is a genetic disease, characterized by attacks of fever and painful manifestations. Several vasculitides are more common in FMF than in the general population. The aim of the study was to define and characterize the association between FMF and Behcet's disease (BD), a form of vasculitis not previously related to FMF.

METHODS

We conducted a retrospective study in which FMF patients, also suffering from BD (FMF-BD), were recruited from about 4,000 patients registered in our clinic, using a computer survey. Patients identified by the screening process were examined, and those meeting the published criteria for the diagnoses of FMF and BD were classified as FMF-BD cases and compared with unselected FMF and BD controls.

RESULTS

The prevalence of BD was higher in FMF than in populations known to be rich in BD (eg, 16 per 4,000 in FMF compared with 1 per 104 in Japan, P < .001). FMF-BD cases and FMF or BD controls were comparable in most demographic, clinical, and laboratory aspects studied. However, more cases than FMF-controls were of Iraqi/Turkish origin and responded less favorably to colchicine. A higher proportion of cases than BD controls had skin, central nervous system, and gastrointestinal manifestations, originated from North Africa, and had family history of BD. In most cases, as in most respective controls, the severity of FMF was of intermediate grade and the extensiveness of BD was limited. The HLA B5 antigen was present in 53% of BD cases and 40% of BD controls.

CONCLUSIONS

BD should be included among the vasculitides complicating FMF. BD and FMF in patients with FMF-BD, and in patients suffering from each of these entities alone, are clinically and demographically comparable.

Oral habits and their association with signs and symptoms of temporomandibular disorders in adolescent girls

A group of 248 randomly selected high school girls, aged 15-16 years, completed a questionnaire and were examined clinically with regard to various oral habits and signs and symptoms of temporomandibular disorders (TMD). Common habits reported in the literature, such as gum chewing, nail biting, biting foreign objects, clenching and bruxism, eating seeds and crushing ice, as well as two less reported habits, 'jaw play' and continuous arm leaning, were evaluated. The most outstanding finding was the high prevalence and intensity of gum chewing among our study group: 92% of the girls chewed daily and 48% chewed gum for more than 3 h a day (intensive gum chewing). Statistically significant associations were found between intensive gum chewing and muscle sensitivity (P<0.001) and joint noises (P<0. 05), and between crushing ice and muscle sensitivity to palpation (P<0.005). A positive association was found between 'jaw play' and joint disturbances: reported joint noises (P<0.01), catching of the joint (P<0.01) and joint tension (P<0.001). A positive association was also found between arm leaning and reported joint noises (P<0. 05), catching (P<0.05), and joint tension (P<0.005). There was no association between the presence of bruxism and muscle sensitivity to palpation or joint disturbances. The potential harmful effects of intensive gum chewing, 'jaw play', continuous arm leaning and ice crushing are presented in this study. In light of these findings, the professional community should address these habits with proper data gathering, examination and consultation.