Sebnem Özkan

Evidence for Borrelia burgdorferi in morphea and lichen sclerosus

Background Borrelia burgdorferi (Bb) infection has been implicated in the development of morphea and lichen sclerosus; however, conflicting results have been reported with different investigational methods from different regions. We looked for evidence of Bb in patients with morphea and lichen sclerosus by polymerase chain reaction (PCR) analysis of of skin biopsy samples.

Circulated Activated Platelets and Increased Platelet Reactivity in Patients With Behçet’s Disease:

Behçet’s disease (BD) is a multisystem disorder. Venous as well as arterial thrombosis is a common complication of BD but exact pathogenetic mechanism of the thrombotic tendency is not well known. This study aimed to evaluate circulating activated platelets and platelet reactivity in Behçet’s patients. Twenty-two Behçet’s patients (4 female, 18 male; mean age 38.6 ± 10.9 years) and 20 control subjects (8 female, 12 male; mean age 38.8 ± 9.4 years) were included. Those patients who had hypertension, hyperlipidemia, peripheral or coronary artery disease, hepatic or renal function abnormality, and who were using aspirin and other platelet-active drugs were excluded. Platelet activity and reactivity to adenosine diphosphate (ADP) were measured by whole blood flow cytometry. We assessed markers of platelet degranulation (P-selectin; CD62P) and the activated glycoprotein IIb/IIIa receptor (PAC1 binding to fibrinogen binding site) before and after stimulation with ADP. Platelet P-selectin expression was not significantly different between patients and control subjects both at baseline (p=0.420) and after stimulation (p=0.56). Baseline (p=0.001) and ADP-stimulated (p=0.003) PAC1 binding was significantly higher in Behçet’s patients than in the control group. Clinical activity has no effect on P-selectin expression and PAC1 binding. There is evidence of platelet activity and hyperreactivity in patients with BD and this may contribute to a prothrombotic state. In addition to aspirin, other antiplatelet drugs may be useful in the prevention and treatment of thrombosis in Behçet’s patients.

Acrodermatitis enteropathica with Pseudomonas aeruginosa sepsis

Abstract: Acrodermatitis enteropathica is characterized by eczematous and scaly plaques on the face, scalp, acral, and anogenital regions. In addition to typical lesions, unusual prominent vesiculobullous lesions are also described. We report a full‐term, 9‐month‐old boy who has acrodermatitis enteropathica and Pseudomonas sepsis. In this patient there were clinical findings of sepsis and eczematous vesiculobullous lesions on the periorificial and acral areas. Serum zinc level was extremely low. Pseudomonas aeruginosa was identified in cultures of blood and fluid which was aspirated from the bullous lesions. After oral zinc sulfate and intravenous antibiotic treatment his condition improved within 2 weeks.

Perianal necrotizing fasciitis in a neonate.

A two-week-old term male infant, weighing 1,600 grams was transferred to the neonatology unit of Doküz Eylul University hospital with sharply demarcated cutaneous gangrene surrounding the perianal region. He did well at birth. In his history, on the 10th postnatal day, a red, painful, warm cutaneous lesion was observed which was thought to be secondary to repeated and inappropriate rectal temperature measurements. Besides an ill-appearing child, a nontender frank cutaneous gangrene developed within several days.Klebsiella pneumoniae was cultured from the involved area. Blood cultures were negative. A frozen section of soft tissue biopsy could not be performed because of the localization of the lesion. The patient was successfully treated by surgical debridement and high doses of parenteral antibiotics.

Naproxen-induced lichen planus: report of 55 cases.

Background  Clinical and histopathological differential diagnosis is usually impossible in drug‐induced lichen planus (LP) and idiopathic LP. Naproxen is a nonsteroidal anti‐inflammatory drug, which is widely used for its analgesic, antipyretic and anti‐inflammatory effects. To the best of our knowledge, two case reports on naproxen‐induced LP have been reported.

Multiple pilomatricoma with perforation

A 22‐year‐old woman presented to our clinic with a complaint of masses on various parts of her body. A mass on her right forearm had appeared 5 years ago and had enlarged during the past 6 months. Two lesions on the back of her neck had a 3‐year history, one lesion on her eyebrow had a 2‐year history, and one lesion on her left forearm had a 1‐year history. The lesion on her left forearm was discharging purulent material.

Task-based learning programme for clinical years of medical education.

CONTEXT Task-based learning (TBL) is an educational strategy recommended for the later years of the medical education programme. The TBL programme was adopted for clinical years in the 2000-2001 academic year in Dokuz Eylul University School of Medicine (DEUSM). OBJECTIVE The aim of this paper is to describe the TBL programme of DEUSM. METHODS DEUSM outlined 50 clinical tasks for fourth-year students and 37 for fifth-year students. The tasks were grouped into four and five blocks. Interdisciplinary practicals, lectures and patient visits were organised in each tasks schedule. The tasks were the focus of learning and each discipline contributed its own learning opportunities to the attached tasks. Formative and summative methods were used to evaluate the programme. CONCLUSION Based on the experience and feedback provided by the students and trainers, the authors considered TBL an applicable and advisable approach for the clinical years of medical education.

Recurrent Leser-Trélat sign associated with two malignancies

The Leser-Trélat (LT) sign refers to the sudden appearance of numerous seborrheic keratoses (SK) or the sudden increase in the number and the size of SK in association with an internal malignancy [1–3]. The existence of the LT sign has been explored for many years; its validity is still a point of controversy [2–6]. We report a patient with the sudden appearance of multiple SK along with a visceral malignancy and within several years a second visceral malignancy occurring along with a sudden increase in the size and number of her SK. A 66-year-old woman was admitted to our clinic with a complaint of several skin lesions occurring on her trunk. She had noticed their development rapidly in the previous 6–7 months. They were associated with mild pruritus. Her medical history included diabetes mellitus, hypertension and mitral and aortic valve insufficiency. Physical examination revealed multiple disseminated sharply demarcated, round or oval verrucous, tan or light brown papules with follicular plugs of 3–10 mm in size on the chest, abdomen and back (fig. 1). They were diagnosed as SK clinically and histopathologically.

Sarcoidosis in a Preschooler with Only Skin and Joint Involvement

Abstract: Sarcoidosis is a multisystemic granulomatous disease of unknown etiology. It is relatively rare in children less than 15 years of age and especially in those less than 5–6 years of age. Sarcoidosis characteristically involves the skin, eyes, and synovial tissues in patients less than 5–6 years of age. We report a 3‐year‐old boy with sarcoidosis who had cutaneous findings with joint symptoms. Dermatologic examination revealed lichenoid, erythematous, 2–3 mm papules, some of them grouped, all over his extremities and trunk. There were symmetric swellings on his ankles and wrists without erythema or pain which did not interfere with function. However, until now, no eye involvement had been detected in the patient.

Comparison of weekly and daily incremental protocols of narrowband ultraviolet B phototherapy for psoriasis

Background  Different protocols have been used for narrowband ultraviolet B (UVB) therapy, commonly used in the treatment of psoriasis; however, more effective and reliable protocols are still required.