Sedat Akdeniz

Intima-Media Thickness and Arterial Distensibility in Behçet’s Disease

The etiology of Behçet’s disease, a systemic vasculitis, is unknown. Vascular involvement may be seen in 25% of patients with Behçet’s disease. Vasculitis make the prognosis of Behçets disease severe. The aim of this study is to examine the structural and functional changes and relations of these changes with progression and prognosis of Behçet’s disease. For this purpose, 40 patients with Behçet’s disease and 40 healthy volunteer control subjects were analyzed, additionally patients with Behçet’s disease were divided into 2 subgroups as those with vascular complications and those without vascular complications. Intima-media thickness and arterial distensibility were measured in all subjects with carotid artery ultrasonography. Carotid artery distensibility was significantly lower in the patient group compared to the control group (0.67 ±0.2, 0.93 ±0.4, p<0.05), and carotid artery IMT was significantly higher (0.59 ±12, 0.80 ±0.11, p<0.05). A statistically significant increase in IMT has been detected (0.77 ±11, 0.86 ±11, p<0.05) in patients with Behçet’s disease with vascular involvement compared to patients with Behçet’s disease without vascular involvement, arterial distensibility in patients with vascular disease was similar with those who has no vascular disease (0.69 ±0.25, 0.63 ±0.25, p>0.05). There was a significant negative linear regression between arterial distensibility and systolic blood pressure (SBP) (B=-1x10-2, p<0.05), and a significant positive linear regression has also been found between IMT and SBP and diastolic blood pressure (DBP) and pulse pressure (PP) (B=6.8x10-3 for SBP, p<0.05, B=6.9x10-3 for DBP, p<0.05, B=6x10-3 for PP, p<0.05). As a result, IMT increases and AD decreases in patients with Behçet’s disease compared to results in the control group. Although more studies are required for this subject, use of noninvasive parameters such as IMT and AD, which reflect the structural and functional characteristics of vasculature, may be useful to define disease progression and subjects at high risk.

An epidemiological study of pityriasis rosea in the Eastern Anatolia.

The purpose of this study was to investigate the epidemiological features of pityriasis rosea (PR) in the Eastern Anatolia, Turkey. Three hundred ninety-one patients (214 females, 177 males) with PR seen during the years 1992–1995 were analyzed for annual incidence among dermatologic outpatients, sex, age, and distribution by month and year. The average annual incidence was 0.75 per 100 dermatologic patients. PR was reported to be slightly more common in women by margin of 1.2:1.0. Eighty-seven of the cases were between the ages of 10 and 39 years, with a peak in the 20–29 age group. The incidence of the disease was much higher in the rainy and snowy months. No declining incidence was observed over the years. Changes in incidence from year to year, though not great, were statistically significant.

Congenital non-familial unilateral basaloid follicular hamartoma

Basaloid follicular hamartoma is not a well‐recognized clinical entity and has often been diagnosed as trichoepithelioma or basal cell carcinoma. It is a unique benign follicular tumour which comprises a variety of clinical manifestations. We present the case of a 24‐year‐old male with unilateral basaloid follicular hamartoma present at birth and later misdiagnosed as basal cell carcinoma. Histological features of basaloid follicular hamartoma are not always diagnostic and clinico‐pathological correlation is particularly important to distinguish this benign hamartoma from other basaloid tumours including basal cell carcinoma. Continuous follow‐up of our patient did not reveal any clinical or histological malignant transformation.

Atypical familial Papillon-Lefèvre syndrome.

The Papillon–Lefèvre syndrome is a rare autosomal recessive disorder. Consanguinity seems a notable prerequisite. Papillon–Lefèvre syndrome manifests in the first 6 months of life with rapidly progressive periodontitis and severe alveolar bone destruction leading to early loss of both the deciduous and permanent teeth in association with palmo‐plantar hyperkeratosis. We present two unusual cases of familial Papillon–Lefèvre syndrome, one of whom has only late onset of mild skin lesions and the other has severe skin lesions and relatively mild periodontal disease. A number of other cases recently described have also had atypical features.

The seroprevalence of varicella zoster antibodies in Behçet's and other skin diseases

The purpose of this study was to investigate the association of the varicella zoster virus (VZV) IgG, and IgM antibodies with Behçets and other skin diseases (group 1: recurrent aphthos stomatitis, fungal infections, psoriasis; group 2: vitiligo, lichen planus). Twenty eight patients with Behçets disease (BD), and 117 patients with dermatological disorders other than BD were evaluated for specific VZV IgG and IgM antibodies by using a third generation enzyme-linked immunosorbent assay (ELISA). The Mantel Heizshel χ2 method was used to adjust the confounding of age and sex of the patients. The serological positivity for VZV IgG and IgM antibodies in BD was not statistically different from other skin diseases. When we considered the age of the patients, χ2 = 2.64, CI (0.27–1.65), odds ratio (1, 1.25, 2.21) (p = 0.10) and when we considered the sex of the patients, χ2 = 0.31, CI (0.81–1.28), odds ratio (1, 1.45, 1.41), (p = 0.57).

Mycosis fungoides with involvement of the oral cavity

Mycosis fungoides rarely involves the oral cavity. To our knowledge only 29 cases of oral cutaneous T‐cell lymphoma have been described up to 1994. This report presents a case of mycosis fungoides with involvement of the oral cavity in a 57‐year‐old man who died from septicemia 7 months after the onset of oral involvement.

Loxosceles reclusa bite to the eyelid.

Purpose The authors report a case of Loxosceles reclusa infestation on the eyelid. Methods The specimen collected by swabbing the lesions with gauze was tested by using a venom-specific enzyme-linked immunosorbent assay Loxosceles venom was detected in specimen. The patient was managed with conservative therapy that included saline compresses and ocular lubrication. Results The case presented with severe edema and necrosis on the left upper eyelid. On laboratory examination, a significant left shift of white blood cell count was detected. Although residual scar of the eyelid and punctate epitheliopathy on the inferior of cornea was detected, vision was not impaired. Conclusions Supportive therapy may be reasonable treatment for Loxosceles reclusa infestation on the eyelids. The presence of venom proteins detected with an enzyme-linked immunosorbent assay technique is beneficial for supporting the diagnosis of Loxosceles envenomatio.

Anesthesia Dolorosa Caused by Penetrating Cranial Injury

Anesthesia dolorosa (AD) is an uncommon complication of surgical treatments for trigeminal neuralgia. Its incidence is around 0.8%. To our best knowledge, AD caused by a penetrating cranial injury has not been reported previously. We report the case of a 31-year-old male patient with left-sided neuropathic keratitis and AD that began 18 years earlier, following a penetrating cranial injury with a knife to the left postauricular area. The patient was successfully treated by a carbamazepine and gabapentin combination. In conclusion, penetrating cranial injury is uncommon but may cause a serious neurologic disturbance. In the differential diagnosis of AD, a penetrating injury should be kept in mind. In these cases, treatments should be effective and immediate; otherwise, this may result in catastrophic consequences such as neurotrophic keratitis and blindness. Ophthalmologists should be aware of these potential problems.

Axillary hyperhidrosis treated with botulinum toxin A exotoxin

The eccrine glands receive sympathetic innervation, and the neurotransmitter involved is acetylcholine. 2 Eccrine sweat glands have been shown to be stimulated by cholinergic as well as adrenergic agonists. 3 Systemic anticholinergic agents frequently have unacceptable side-effects. Surgical treatments, such as transthoracic sympathectomy often fail to cure axillary hyperhidrosis, and complications may include pneumothorax and compensatory hyperhidrosis in other parts of the body. 4

Kyrle's disease in diabetes mellitus and chronic renal failure.

To the Editor: The association of perforating dermatoses with renal disorders andor diabetes mellitus has recently been a focus of attention. We report two male patients with chronic renal failure secondary to diabetic nephropathy who developed the typical clinical picture of Kyrle’s disease. Both patients had terminal-stage renal disease and died face of renal failure within 1 year. Case 1. A 54-year-old male patient with diabetes mellitus, type 11, and chronic renal failure secondary to diabetic nephropathy had developed pruritic hyperkeratotic papules, initially located on the limbs but later more generalized, since November 19%. There was no previous history of skm disease, nor was there any slgruficant family history. Physical examination showed numerous small to large red-brown papules and nodules, with a central, dome-shaped keratotic plug, scattered over the limbs and trunk, but with a predominance on the legs (Fig. 1). The lesions were non-confluent and partly follicular. During the period April 1996 to May 1997 blood urea ranged from 73229 mg/dl, serum creatinine 2.0-9.5 mg/dl; results of repeated fasting blood glucose tests ranged from 128 to 216 mg/dl. Histology of a skin biopsy showed follicular and perifollicular, hyperkeratotic, focally parakeratotic plugs penetrating through the epidermis into the dermis. A chronic inflamatory infiltrate was noted in the adjacent dermis. Topical corticosteroids and topical retinoids were ineffective; subsequent treatment consisting of 20 mg acitretin on alternate days (low dose because of renal failure) was partly effective. The patient died of chronic renal failure in May 1997. Case 2. A 14-year-old boy with chronic renal failure and juvenile diabetes mellitus presented pruritic, hyperkeratotic papules which had gradually become more generalised since March 1997. On physical examination, numerous small papules with central keratotic plugs were found in a widespread distribution (Fig. 2). During the period 1992-1997 fasting blood glucose ranged from 148 to 342 mg/dl, serum creatinine 2.0-8.6 mg/dl, blood urea 87-217 mg/dl. Skin biopsy specimen revealed a heavily keratotic, partly parakeratotic plug with invagination of the epidermis. No epidermal perforation was found. Treatment consisted of 20 mg acitretin on alternate days. SECTION\ \