Mustafa Kulac

Clinical importance of Demodex folliculorum in patients receiving phototherapy.

Background  Patients with immunodeficiency are prone to infestation with Demodex folliculorum mites. Ultraviolet (UV) radiation can lead to immunosuppression and sebaceous gland hyperplasia. Although some cases of demodicidosis related to UV radiation exposure have been reported, no studies have been performed on the incidence of D. folliculorum and its clinical characteristics in patients receiving phototherapy.

Temperament and character profile in patients with essential hyperhidrosis.

Background/Aims: The main debates on hyperhidrosis are whether there are some personality features such as anxiety or stress, or whether the psychological symptoms are due to negative social feedback from early life. We aimed to investigate the temperament and character dimensions with a psychobiological inventory. Methods: We recruited patients with hyperhidrosis (n = 26) and chronic renal failure (n = 44) as well as healthy subjects (n = 22) from dermatology and nephrology clinics and the general population in Afyonkarahisar. All subjects were required to perform a temperament and character inventory. Results: The total novelty seeking score in hyperhidrosis was significantly lower than in controls. There was no significance in total harm avoidance scores between hyperhidrosis patients and controls. The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients. Conclusion: The higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or personality disorder.

Erythrocyte Oxidant/Antioxidant Status in Essential Hyperhidrosis

Essential Hyperhidrosis is a disorder of excessive, bilateral, and relatively symmetric sweating occurring in the axillae, palms, soles, or craniofacial region without obvious etiology. Nitric oxide may play a physiological part in the production and/or excretion of sweat in skin eccrine glands. Tempol, a SOD mimetic, increases the half-life of NO and results in vasodilatation, hypotension, and reflex activation of sympathetic nervous system. Reactive oxygen species (ROS) may directly activate both central and peripheral sympathetic nervous system activity. We assessed the levels of malondialdehyde (MDA), the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) of red blood cells in patients with essential hyperhidrosis (n = 31) compared to age-and sex-matched healthy controls (n = 28). Erythrocyte activities of SOD and level of MDA were detected significantly higher (p = 0.020, p = 0.004 and respectively) and activities of CAT and GSH-Px were significantly lower (p = 0.0001, p = 0.0001 respectively) in patients than controls. Our results support the hypothesis that oxidative damage resulting from increased ROS production along with insufficient capacity of antioxidant mechanisms may be involved in pathogenesis of EH.

Evaluation of myocardial perfusion and function by gated SPECT in patients with Behçet's disease.

BackgroundBehçet’s disease (BD) is a systemic multi-system vasculitis that can have a wide range of effects on the cardiovascular system.ObjectiveTo determine the existence of myocardial perfusion defects caused by coronary microvascular dysfunction in BD and to evaluate coronary arterial distribution and left ventricular systolic function by gated single-photon emission computed tomography (SPECT).MethodsThe study population consisted of 23 (15 men and 8 women) patients with BD and 20 healthy controls (12 men and 8 women). Technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) gated SPECT studies were performed at stress and rest in a 2-day protocol. Stress and rest left ventricular ejection fraction (LVEF) were calculated. Using non-gated SPECT images myocardial perfusion scores [summed stress score (SSS), summed rest score (SRS), summed difference score (SDS), and fix defect score (FDS)] and perfusion defect extent as percentage (stress, rest ischemic, and fix %LV) were determined. Using gated SPECT images, wall motion score indices (stress wall motion score indices and rest wall motion score indices) were calculated. Coronary angiography (CAG) was applied to patients with abnormal myocardial perfusion scintigraphy (MPS).ResultsThe mean ages of the BD and control groups were 39.3 ± 10.6 years and 36.2 ± 8.3 years, respectively. No statistically significant differences were observed between the two groups regarding clinical features and cardiologic findings. Abnormal MPS was found in 13 (56.5%) of the BD patients; 3 patients had non-transmural infarcts and 10 patients reversible perfusion defects. Reversible perfusion defects were also found in two controls (10.0%). When the two groups were compared regarding the gated SPECT findings, differences were determined in the following parameters; SSS, SRS, SDS, FDS, stress and rest LVEF, stress and rest %LV, and stress and rest WMSI. In the BD group, when gated SPECT results were compared between those with and without abnormal MPS, differences were determined in SSS, SRS, SDS, FDS, stress and rest %LV, and stress and rest WMSI. Epicardial coronary arteries were normal in CAG.ConclusionsMyocardial perfusion and function are disturbed owing to influenced coronary microvascularity in BD, and CAG is frequently observed to be normal. Gated SPECT is a non-invasive reliable method that simultaneously evaluates the existence, extent and severity of myocardial ischemia or infarction and the wall movements in cardio-Behçet.

Giant Proliferating Trichilemmal Tumor of the Gluteal Region

Background Proliferating trichilemmal tumors are rare cutaneous neoplasms that show features of typical pilar cysts but also show extensive epithelial proliferation, variable cytologic atypia, and mitotic activity. Proliferating trichilemmal tumors are benign lesions; however, there are numerous reports of malignant proliferating trichilemmal tumors. Objective We present a case of benign proliferating trichilemmal tumor of an 81-year-old woman that was located on the left superior gluteal region for 30 years. Methods A tumor measuring 9 × 7 cm was surgically excised with a 1 cm conservative margin of normal tissue. Results Based on the histopathologic findings of tumor, this case was diagnosed as proliferating trichilemmal tumor. The patients condition was successfully treated with total excision. Conclusions Our case is an unusual presentation of proliferating trichilemmal tumor. Physicians should be aware of this entity while differentiating cutaneous tumor located on the gluteal region.

Venous Insufficiency in Patients With Toenail Onychomycosis

Onychomycosis is a common fungal infection of the toenails and can originate secondary to vascular abnormalities. The aim of this study was to evaluate the relationship between onychomycosis and venous insufficiency.

Demodex folliculorum in patients with rheumatoid arthritis

The objective of this study was to investigate the incidence and density of Demodex folliculorum in the patients with rheumatoid arthritis (RA). Forty-one patients with RA and twenty-seven age and sex matched healthy controls were enrolled in this study. Disease Activity Score (DAS 28) was used for the assessment of disease activity. Out of 41 patients, 33 were females and 8 males. The mean disease duration was 10.9 ± 8.2 years. The mean DAS 28 was 3.8 ± 1.2. No statistically significant differences in the incidence and density of Demodex mites were found between patients with RA and controls. Although immunosuppression is thought to be a risk factor for the D. folliculorum infestation no such correlations could be found in the 41 immunosuppressed patients with RA, therefore, further studies with larger groups are needed.

A rare cutaneous tumor of the axilla: Apocrine adenocarcinoma

Sweat gland neoplasms are rare with approximately 200 cases of eccrine sweat gland and less than 50 cases of apocrine gland carcinoma being reported in the worldwide literature. More than half of the reported cases with apocrine adenocarcinoma had lymph node metastases at the time of diagnosis. We report a case of a 56-year-old man, presented with a left axillary slow-growing seven year old painless nodule. Histopathological examination revealed an invasive apocrine adenocarcinoma with lymph node metastases. The patient successfully treated with total excision and radiotherapy. Apocrine adenocarcinoma is a rare malignancy with high metastatic potential that occurs mostly in the axilla. Physicians should be aware of this entity while differentiating cutaneous tumor located on the axillary region.

No apparent correlation between Behcet's disease and oxidative stress disturbance

UNLABELLED Behçets disease (BD) is a chronic, progressive and inflammatory multisystemic disease, that significantly affects the cardiovascular system. Oxidative stress (OS) is a disturbance in oxidant/antioxidant balance in favor of oxidants. The OS that increases acutely and chronically due to the inflammatory process plays an important role in the pathogenesis of the cardiovascular system effects of the disease by causing endothelial dysfunction in vascular structures. The aim of our study was to investigate the relationship between OS and myocardial perfusion, which is based on microvascular dysfunction, in BD. MATERIAL AND METHOD Twenty-seven patients with BD (16 M, 11 F, mean age: 38.7 +/- 9.4 years) and 22 healthy volunteers (12 M, 10 F, mean age: 35.8 +/- 6.5 years) participated in our study. Technetium-99m methoxyisobutylisonitrile single photon emission computed tomography (Tc-99m MIBI SPECT) stress-rest test was performed with two-day protocol. Myocardial perfusion scores (summed stress score, summed rest score, summed difference score, fix defect score) and perfusion defect prevalence (stress, rest, ischemic and fixed) were determined as the percentage of left ventricle. Coronary angiography was performed in patients with abnormal myocardial perfusion scintigraphy. For OS analysis, the blood samples were taken immediately before the first imaging procedure and were studied for malondialdehyde, glutathione, nitrite, nitrate, vitamin C, retinol, and carotene. RESULTS In the BD group, a total of 9 patients had abnormal findings in their stress and rest electrocardiography. Perfusion defect in myocardial perfusion scintigraphy was observed in 14 patients (51.8%). Twelve patients accepted coronary angiography, and their results were normal. In the comparison of myocardial perfusion scores, perfusion defect prevalence and OS parameters, there was a significant difference between the BD and control groups. In the BD group, no correlation was observed between myocardial perfusion scores, perfusion defect prevalence and OS parameters. CONCLUSION Defects in myocardial perfusion and increase in OS were observed in BD; however, there was no correlation between the two findings in the inactive period. In other words, the prevalence and intensity of myocardial perfusion defects can vary at different OS levels.

Ayın olgusu Olgu Sunumu

Multipl sclerosis is a chronic disease of the central nervous system characterized by discrete areas of demyelination and axon injury The occurrence of multipl sclerosis in children younger than 16 years has been found to between 2 5 The incidence of posterior fossa plaques and tumefactive lesions were higher in children A fourteen year old boy who had a history of acute disseminhated encsephalomyelitis one year before and demosttrated tumefactive plaques confused with tumor or abscess in the second attack was diagnosed as multipl sclerosis Current knowledge of nbsp; the diagnosis differential diagnosis and therapy of nbsp; multipl sclerosis are discussed Key words: child interferon beta nbsp; multipl sclerosis tumefactive plaque