Canten Tataroglu

Exteroceptive Suppression Patterns of Masseter and Temporalis Muscles in Central and Peripheral Headache Disorders

The objective of this study was to compare the exteroceptive suppression patterns of masseter and temporalis muscles in patients with primary and secondary headache disorders originating from peripheral joint dysfunction. We accomplished the temporalis and masseter exteroceptive suppression in 28 patients with migraine, 25 patients with chronic tension-type headache (CTH), 22 patients with temporomandibular joint (TMJ) dysfunction and 18 healthy controls. The onset latencies and duration of the first suppression period (S1) was not significantly different between the patients and controls. The duration of the second suppression period (S2) was shorter in patients with CTH, migraine (analysed during attack) and TMJ dysfunction than those obtained from controls. A distinctive finding was significantly prolonged onset latency in patients with TMJ over those obtained from patients with CTH and migraine. We concluded that the onset latency of the S2 period is a useful parameter in the differential diagnosis of primary and peripheral headache disorders.

Celecoxib-induced photoallergic drug eruption.

Photoallergic dermatitis is caused by a photosensitizing substance plus sunlight exposure in a sensitized person. If the photosensitizer is delivered internally, it is called a photoallergic drug reaction. Celecoxib is a new generation non‐steroidal anti‐inflammatory drug and sulfonamide derivative. We report a photoallergic drug eruption associated with the introduction of celecoxib. To our knowledge, this is the first report of photoallergic drug reaction associated with celecoxib.

The effects of exogenous L-carnitine on lipid peroxidation and tissue damage in an experimental warm hepatic ischemia-reperfusion injury model

BACKGROUND l-Carnitine is the essential endogenous factor for the transport of long-chain fatty acids from the cytoplasm to within the mitochondrion where the β-oxidation process takes place. l-Carnitine is a superoxide scavenger and an antioxidant that possesses an anti-ischemic action and a stabilizing effect on cell membranes. It may be of help in liver ischemia reperfusion injury. RESULTS regarding the effects of l-carnitine on liver ischemia and reperfusion injury are few and conflicting. OBJECTIVE The aim of this study was to investigate the efficacy of exogenous l-carnitine on lipid peroxidation and protecting liver at different stages of experimental total warm hepatic ischemia-reperfusion (TWHIR) procedure in rats. METHODS This experimental study in healthy, weanling, male Wistar rats (weighing 180-200 g) was conducted at the Experimental Animal Research Laboratory of the Faculty of Medicine of Mersin University, Mersin, Turkey. Rats were randomly divided into 5 groups: (A) Control group; (B) TWHIR procedure only; (C) l-carnitine administered 2 hours before the TWHIR procedure; (D) l-carnitine administered just before the TWHIR procedure; and (E) l-carnitine administered after total warm hepatic ischemia but just before the reperfusion procedure. Total warm hepatic ischemia (via the Pringle maneuver) and reperfusion were performed for 45 and 30 minutes, respectively. l-Carnitine (200 mg/kg) was administered intravenously. At the end of each procedure a blood sample was drawn and total hepatectomy was performed following reperfusion. Malondialdehyde (MDA) and myeloperoxidase (MPO) levels of both plasma and liver tissue, total antioxidant capacity (TAOC), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in plasma, and histopathologic examination were analyzed to assess lipid peroxidation and damage in liver tissue. RESULTS Thirty-four rats (mean [SD]age, 59.26 [1.2]days; mean [SD] weight, 194.1 [5.1] g) were used in the study. There was a significant difference observed between groups A (n = 5) and B (n = 5) for all evaluation parameters. The TWHIR procedure performed in group B was associated with significant increases versus baseline in ALT, AST, MDA, and MPO in plasma, and MDA and MPO in liver tissue, but a significant decrease of TAOC in plasma. ALT, AST, serum and liver MDA, and MPO levels of group B were significantly higher than all groups administered l-carnitine. l-Carnitine administration between total warm hepatic ischemia and reperfusion was associated with a significant attenuation in all parameters. The liver MDA levels of groups C (n = 8) and D (n = 8) were significantly lower than that of group E (n = 8) (mean [SD]: C, 16.53 [3.32] and D, 18.28 [1.67] vs E, 23.05 [3.52]; P = 0.001 and P = 0.016, respectively). The mean (SD) liver MPO level of group C (1.09 [0.16]) was significantly lower than that of groups D (2.12 [0.25]) and E (2.11 [0.28]) (both, P = 0.001). The TAOC of group B (0.77 [0.12]) was significantly lower than that of groups C (1.34 [0.19]) and D (1.08 [0.20]) (P = 0.001 and P = 0.015, respectively). The TAOC of group C was significantly higher than that of the other l-carnitine groups (E, 0.94 [0.13]) (P = 0.023 vs group D; and P = 0.001 vs group E). Histopathologic scores of groups A, C, and E were significantly lower than that of group B, but the difference between groups B and D was not statistically significant. CONCLUSIONS In this experimental study, administration of exogenous l-carnitine was associated with significantly decreased lipid peroxidation in plasma and liver tissue when administered prior to a TWHIR procedure. In addition, l-carnitine seemed to be more effective with regard to decreasing lipid peroxidation in liver tissue when administered before warm hepatic ischemia. l-Carnitine was associated with significantly decreased leukocyte sequestration in plasma and liver tissue. A significant increase in TAOC was associated with l-carnitine administered prior to ischemia. These observations suggest that l-carnitine might have a protective effect against ischemia-reperfusion injury in rat liver tissue.

Effects of Cilostazol on Oxidative Stress, Systemic Cytokine Release, and Spinal Cord Injury in a Rat Model of Transient Aortic Occlusion

BACKGROUND Cilostazol is a phosphodiesterase inhibitor that has anti-inflammatory potential in addition to vasodilator and antiplatelet effects. The aim of this study was to determine the influence of cilostazol on biochemical markers of oxidative damage, proinflammatory cytokine release, and spinal cord injury after transient aortic occlusion in rats. METHODS Animals were randomized into 3 groups. Sham group rats were subjected to laparotomy without aortic occlusion. Control group rats were pretreated with intraperitoneal dimethyl sulfoxide, and cilostazol group rats received intraperitoneal cilostazol (20 mg/kg/day) for 3 days before the induction of ischemia. Ischemia was induced by clamping of the infrarenal aorta, and 48 hours after reperfusion, Tarlov grades were assessed and spinal cord conduction velocities (SCCVs) were measured using epidural electrical stimulation. Erythrocyte superoxide dismutase (SOD) and catalase activities and plasma malondialdehyde, serum tumor necrosis factor-α, interleukin-1β, and interleukin-6 levels were analyzed. Spinal cord histopathology was examined to determine neuronal damage and tissue inflammation. RESULTS Aortic occlusion caused significant increases in SOD, catalase activities, and malondialdehyde and cytokine levels accompanied by spinal cord injury. Cilostazol significantly reduced malondialdehyde levels but did not significantly alter the activations of antioxidant enzymes, levels of proinflammatory cytokines, or histologic severity of inflammation. The differences regarding the results of Tarlov grading, SCCVs, and neuronal viability between the ischemic and cilostazol pretreated groups were statistically nonsignificant. CONCLUSION The present experimental study indicated that cilostazol pretreatment used in this study before aortic occlusion decreased lipid peroxidation, which may be related to the reduction of reactive oxygen species. Cilostazol did not significantly suppress systemic cytokine release and prevent spinal cord inflammation and injury; however, it did show some benefit. Additional investigations might be needed to determine the critical dose of cilostazol for clarifying the protective role of this drug in spinal cord ischemia/reperfusion injury.

Eruptive vellus hair cysts: an effective extraction technique for treatment and diagnosis

Background  Eruptive vellus hair cysts are uncommon developmental anomalies of vellus hair follicles that are observed in young patients. Two patients were evaluated for asymptomatic flesh‐coloured papules appearing on the chest, abdomen and axillae. Lesions of both patients were diagnosed histologically as eruptive vellus hair cyst, which is a disorder with no standard treatment option.

The eclipse naevus and cockade naevus: are they two of a kind?

of excessive fat deposits, and weight loss might also be beneficial. While the genes for congenital generalized lipodystrophy and familial partial lipodystrophy have recently been idendified, the pathogenesis of acquired partial lipodystrophy remains unknown. However, it has been associated with autoimmune diseases, in particular renal disease. Up to one-third develop mesangiocapillary (membranoproliferative) glomerulonephritis, typically years after the onset of the lipodystrophy. Complement anomalies have been implicated in its pathogenesis. Patients commonly have low complement C3 levels and circulating C3 nephritic factor, and in vitro studies have shown C3 nephritic factor to cause lysis of adipose tissue. Other reported associations include systemic lupus erythematosus, dermatomyositis, hypothyroidism and pernicious anaemia, coeliac disease and dermatitis herpetiformis, rheumatoid arthritis, temporal arteritis, leucocytoclastic vasculitis, Raynaud’s phenomenon and cutaneous vasculits, and POEMS syndrome. In most cases the partial lipodystrophy preceded the associated disorder by years. C3 nephritic factor was not detected in the majority of these cases, suggesting another factor responsible for the changes seen in patients with partial lipodystrophy.

Microscopic polyangiitis presenting with medullary infarct

Microscopic polyangiitis is a small vessel vasculitis which is rarely associated with ischemic stroke. Cerebrovascular disease has rarely been reported in connection with this disease. It may cause fatal hemorrhage, hemorrhagic conversion and multiple lacunar infarcts. We report here a 55-year-old woman with left medullary oblangata infarction without any symptoms of microscopic polyangiitis. During hospitalization, retinal ischemia, mononeuritis multiplex and pulmonary infiltration developed. Sural nerve biopsy was concomitant with small vessel vasculitis. Elevated CRP and sedimentation and positive P-ANCA led to confirmation of a diagnosis of microscopic polyangiitis. Our patient is a rare case of microscopic polyangiitis presenting with medullary infarction. Although the characteristics of this disease are well-known, the first symptom can be a medullary infarction, which has not been reported in literature before.

β-CATENIN AND CD44 EXPRESSION IN KERATOACANTHOMA AND SQUAMOUS CELL CARCINOMA OF THE SKIN

CD44 and β-catenin are adhesion molecules expressed on a wide variety of cells. Failure of this expression is believed to lead to disruption of cell-cell adhesion and to neoplasia. The aim of this study was to investigate the staining intensity of CD44 and β-catenin in keratoacanthomas and squamous cell carcinomas of the skin. The proliferation index, PCNA staining, was also evaluated in these cases. The abnormal expression of β-catenin significantly predominated in squamous cell carcinomas (n = 20, 76.9%) compared with keratoacanthomas (P = 0.002, χ2 = 7.8). Most keratoacanthomas (n = 11, 61.1%) more frequently showed strong staining intensity with CD44 compared with squamous cell carcinoma (P = 0.001, χ2 = 13.7). The proliferation index was higher in squamous cell carcinoma (P = 0.000, χ2 = 12.8). These findings suggest that CD44 and β-catenin expression may have an important role in the development of malignancy and in the determination of biological features of keratoacanthoma and squamous cell carcinoma of the skin.

Cutaneous Metastasis of Gallbladder Adenocarcinoma in a Patient with Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature

Skin metastasis of primary gallbladder tumors is extremely rare with a reported incidence of 0.7~9% and it usually involves the thorax, abdomen, the extremities, neck, head region, and scalp. Cutaneous metastasis may occur synchronously or metatochronously. In the present case, the patient had chronic lymphocytic leukemia, which was being treated with an alkylating agent (chlorambucil) when the patient developed skin metastasis from gallbladder adenocarcinoma during post- cholecystectomy follow-up. Given the fact that secondary malignancies occur in chronic lymphocytic leukemia; this clinical setting warrants attention. We aimed to discuss secondary malignancy in chronic lymphocytic leukemia patients and gallbladder adenocarcinoma with skin metastasis, based on a review of the literature and the presented case.

Thrombotic thrombocytopenic purpura as the first manifestation of metastatic adenocarcinoma in a young woman

Thrombotic microangiopathy occurs in 5-10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patients refusal. Although chemotherapy including cis-platinum, infusional 5-fluorouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.