Kisinin kendi kilini karsi konulamaz bir sekilde cekip koparmasi olarak tanimlanan trikotilomani, DSM-IV-TR'da Baska Turlu Adlandirilamayan Durtu Kontrol Bozukluklari basligi altinda siniflandirilmaktadir. Bu davranis, artmis ofke ve kaygi gibi duygular nedeni ile ortaya cikan gerilimi ortadan kaldirmak icin yapilmaktadir. Olgumuz, tum gece boyunca uyurken sacini koparma ve altini islatma bulgulari gosteren 11 yasinda erkek cocuguydu. Ayirici tani icin olgumuza tum gece suresince uyku sirasinda polisomnografi uygulanarak, epileptik desarjlarin ayirt edilmesi amaclandi. Sonuclar normal sinirlarda bulundu. Trikotilomani on tanisi tartisildi. Trikotilomaninin parasomni tanisi adi altinda degerlendirilmesinin daha uygun olacagi sonucuna varildi.
Merkel cell carcinoma (MCC) of skin is a rare tumor with aggressive behavior. Local recurrences, regional lymph node and distant metastases of MCC are frequent but to date metastasis to upper gastrointestinal tract was reported only a few. We present a 75-yearold man who had primary MCC at his left thigh. The tumor was excised and the patient was directed to local radiotherapy. He had developed abdominal and thoracal subcutaneous metastatic nodules within 5 and 8 months after surgical excision, respectively. In the tenth month, a second operation had to be performed because of a perforated duodenal ulcer and incidentally a submucosal yellow-white nodule measuring 2 cm in diameter was found in the wall of gastric cardia and excised. This lesion was histologically identical to the primary tumor, hence, gastric metastasis of MCC. The patient rejected further therapy and died 17 months after the initial diagnosis. Differential diagnosis of MCC and distinction of gastrointestinal MCC metastasis from primary neuroendocrine tumors may be difficult. Clinical information and histopathological features along with the results of immunohistochemical stainings are very important in this distinction. Derinin Merkel hucreli karsinomu (MHK) agresif davranisli, nadir bir tumordur. Merkel hucreli karsinomun lokal rekurrensleri, bolgesel lenf nodu ve uzak metastazlari sik olmakla birlikte bildirilen ust gastrointestinal metastaz oldukca azdir. Yetmis bes yasindaki erkek hasta, sol bacagindaki MHK eksize edildikten sonra lokal radyoterapiye yonlendirilmistir. Tumor eksizyonundan sonraki 5. ayda karinda, 8. ayda toraks duvarinda subkutan metastatik noduller gelismistir. Ilk operasyondan 10 ay sonra perfore duodenal ulser nedeniyle yapilan ikinci operasyon sirasinda rastlantisal olarak midede, kardia duvarinda farkedilen 2 cm capli, sari-beyaz renkli, submukozal nodul eksize edilmistir. Bu lezyon MHKa#39;un mide metastazi tanisi almistir. Hasta daha ileri bir tedaviyi reddetmis ve baslangictaki tanidan 17 ay sonra yasamini yitirmistir. MHKa#39;un ayirici tanisi ile gastrointestinal MHK metastazlarinin primer noroendokrin tumorlerden ayrimi zorluk yaratabilir. Bu tur tani sorunlarinin cozumunde klinik bilgi, histopatolojik ozellikler ve immunohistokimyasal calismalar oldukca onemlidir.
A 31-year-old man presented with a twenty-year history of a slowly growing nodule on his scalp in the postauricular area. The lesion was excised and with the clinical and histological findings, it was diagnosed as a pilonidal sinus. The purpose of this review is to report the unusual occurrence of a pilonidal sinus on the scalp and review the literature regarding especially this location.
Neonatal compartment syndrome is a rare condition mainly involving the upper extremity with ulcerated and necrotic lesions. It should be evaluated in detail due to the similarity with other conditions like necrotizing fasciitis, neonatal gangrene, and congenital varicella, etc. Early diagnosis and treatment have a paramount importance for the best outcome. To emphasize this, we would like to present a newborn with the forearm compartment syndrome diagnosed promptly and treated surgically.
Objective: Quercetin has been shown to inhibit the proliferation of cancer cells. Tamoxifen is used for breast cancer. In this study, we have aimed to investigate the effects of quercetin and tamoxifen on telomerase enzyme activity and apoptosis in two cell lines.Methods: In this study, 10, 50 and 100 µM of quercetin and tamoxifen were used to treat MCF-7 and NIH-3T3. Apoptosis was determined by the TUNEL method (Terminal Deoxynucleotide Transferase dUTP Nick End Label) and telomerase enzyme activity was determined by ELISA (Enzyme-Linked Immunosorbent Assay). Results: In the NIH3T3 cell line, only 100 µM quercetin and tamoxifen induced significant apoptosis. In the MCF-7 cell line 10 µM and 100 µM quercetin in the 24th hour and 100 µM quercetin in the 72nd hour induce apoptosis. In 24th and 48th hours, 50 µM tamoxifen and 100 µM tamoxifen in the 24th and 48th hours induce apoptosis in the MCF-7 cell line. In MCF-7 and NIH-3T3 cell lines, all doses of quercetin and tamoxifen reduced telomerase enzyme activity compared to the control group. Conclusion: In this study, it was shown that quercetin has similar effects to tamoxifen. However quercetin induces apoptosis more than decreasing telomerase enzyme activities, being different from tamoxifen. We hope that the findings will assist in developing new therapeutic pathways for preventing breast cancer. However, there should be many more studies in order to discover quercetin and other potential drugs.
Objective: It is known that oxidative stress could be an important factor in the pathogenesis of vitiligo disease. We aimed to investigate the possible relationship between vitiligo pathogenesis and the change of antioxidant capacity of skin and plasma in patients with vitiligo.Material and Methods: In this study we have examined normal and vitiliginous skin and plasma GPx, SOD and CAT activities by spectrophotometric methods in 40 vitiligo patients and 15 controls.Results: Results of tissue enzyme activities (as U/mg prt and Mean SD); were 0.64+/-0.09; 0.89+/-0.15; 0.41+/-0.57 for SOD enzyme, 170.98+/-12.35; 182.13+/-13.48; 121.91+/-16.03 for GPx enzyme and 78.92+/-10.34; 94.99+/-10+47; 55.95+/-7.24 for CAT enzyme in involved skin, uninvolved skin and control groups respectively. Plasma levels of these enzymes were 37.19+/-1.53; 39.53+/-3.32 SOD enzyme, 381.57+/-12.67; 346.13+/-21.90 for GPx and 66.72+/-8.86; 61.24+/-6.32 for CAT enzyme in vitiligo and control groups respectively.Conclusion: There is no correlation between skin and plasma antioxidant enzyme activities in vitiligo patients, or in healthy controls. High glutathione peroxidase and catalase activities in vitiligous skin (p<0.05) especially might be a result of anti oxidative stress response against oxidative stress via peroxides.
Objective: Total knee arthroplasty (TKA) is a major risk factor for thrombosis in patients over 40 years of age and this risk persists for several weeks after the surgery. Since inflammatory mechanisms affect coagulation and the natural anticoagulant system, we aimed to investigate protein C activities and inflammatory markers in patients undergoing TKA surgery.Material and Methods: We included 20 osteoarthritis patients and 20 healthy controls. Protein C activity and tumor necrosis factor-α (TNF-α) levels in plasma and synovia were evaluated by ELISA technique. Results: In the patient group, protein C activities decreased and TNF-α levels increased significantly both in synovia and plasma when compared with the controls. Erythrocyte sedimentation rate of the patient group was found to be significantly elevated in comparison to the controls. On the other hand, serum C reactive protein values increased insignificantly when compared to controls.Conclusion: The decreased activity of protein C and increased levels of inflammatory markers in preoperative plasma and synovia of the patient group may enhance the risk for developing thrombosis.
Objectives: The purpose of this study was to test the hypothesis that the hemostatic agent (FastAct) exerts favourable effect on wound healing and tissue repair alone and along with prilocaine hydrochloride in vivo. Wound healing process is a complex procedure that starts with bleeding and hemostasis. Comprising of bovine factor proteins II, VII, IX and X, FastAct is used as a catalyst in the clot formation process to activate factors II, V, VIII and XIII.Materials and Methods: The study was performed on 21 Wistar male rats. Cutaneous incisions at the length of 4 cm. were made on the dorsal side of all animals. In seven, FastAct was applied alone between the wound edges and, in the other seven, FastAct was applied along with prilocaine. The wounds were sutured by resorbable suture material.Results: The specimens were obtained on the seventh day. Wound breaking strength test was performed before histological examination. In the FastAct group the epithelialization and the closure of the wound edge were better than the other groups. The results of the breaking strength test showed that the results were best in FastAct group.Conclusion: It's concluded that FastAct accomplished hemostasis, facilitated wound healing in accordance with natural processes.
Metastatic lesions in the tongue are extremely rare. A 60-year-old man with lung adenocarcinoma is presented in this report. He had no metastases except simultaneous tongue and cervical lymph node metastases. Metastatik lezyonlar dilde oldukca nadir gorulur. Bu yazida dil metastazi bulunan akciger adenokarsinomlu 60 yasinda erkek hasta sunuldu. Hastanin dil ve servikal lenf nodu metastazlari disinda uzak metastazi saptanmadi.
Cortical vein infarction without dural sinus involvement is extremely rare. Herein, we present three patients with headache, partial seizure and right-sided numbness. On neurological examination, focal neurologic deficit was not observed in our patients. Magnetic resonance imaging revealed cerebral ischemia which showed as hypointense on T1-weighted images and hyperintense on T2-weighted images that do not follow the boundary of arterial territories, indicating cortical venous infarct. Cortical venous infarct should be suspected in patients who present with sudden onset headache and/or focal epileptic seizures even if there is no neurologic deficit. The diagnosis and treatment of cortical venous infarct should be considered as an emergency because of the high potential for full recovery with anticoagulant treatment.
Objectives: The prevalence of sexual dysfunction in Behcet patients, patients' practices toward sexual problems, pre-disease sexual life and distribution of post-disease sexual problems were evaluated.Patients and Methods: Sexually active 96 patients were included to the study. The data were collected with the "Sexual Problems in Behcet Patients Data Collection Form" and "Arizona Sexual Experience Scale (ASES)". The scale's score interval is 5-30; 11-above scores indicate sexual dysfunction.Results: Of the patients, 51 (53.1%) were 40-year-old and above, 49 (51%) were women; the most frequent symptoms were oral aphtosis (58.3%), genital ulcers (31.2%), and erythema nodosum (28.1%). Mean ASES score was 14.2+/-5.8 66 patients (68.7%) had sexual dysfunction. The most prevalent problems were decreased frequency of intercourse (n=32, 86.5%), painful sexual relation (n=18, 48.6%) and unwillingness (n=9, 24.3%). Most of the patients (n=15, 40.5%) who expressed sexual problems were not using any practice for the solution. None of the patients received any information about sexual problem and the most preferenced source of information would be the doctors (n=83, 86.4%) in case having this opportunity. Female gender and the belief about the impact of Behcet's disease on sexual life determined ASES score (43%).Conclusion: Sexual dysfunction in Behcet's disease was seen in a significant proportion.
Osteomas are benign, typically slow-growing tumors composed of densely sclerotic, well circumscribed bone. Laryngeal osteomas are extremely rare. We report an extremely rare case of laryngeal osteoma. The patient had complaints of dysphonia for 3 years and, dyspnea for 1 month. There was a supraglottic mass filling the laryngeal lumen on indirect laryngoscopic examination. Mass was completely excised using microlaryngoscopic instruments. After the operation, the patient's complaints were completely resolved. Case reports and a review of the world literature concerning laryngeal osteoma and treatment are presented.
Objective: The aim of this study is to evaluate the efficacy of dipyridamole in relieving the vasospasm of coronary artery bypass grafts. Material and Methods: Twenty two patients who underwent elective coronary artery bypass grafting (CABG) were admitted to the study (Men/Women:14/8, mean age: 62.4±8.8 years). Ten samples from left internal mammary(LIMA), radial arterial (RA) and saphenous vein (SV) grafts were collected for each. The samples were transported to the vascular laboratory in 4°C Krebs solution. Submaximal smooth muscle contraction was achieved first by 10-7M of phenylephrine solution. Dipyridamole was then added, starting from a concentration of 10-9M to a concentration of 10-3.5M in two minutes intervals and half logarithmic dose increments. The concentration-response curves were obtained of the vasodilatation response relative to the begining.Results: In the LIMA graft samples, the vasodilation response to dipyridamole was 43.2±1.6% and 97.6±4.1% at concentrations of 10-6M and 10-3.5M respectively. In RA graft samples, the vasodilation response to dipyridamole was 36.3±1.8% and 95.3± 2.7% at concentrations of 10-6M and 10-3.5M respectively. In SV graft samples, however, the vasodilation response to dipyridamole was 43.2±1.4 % and 96.6± 2.2% at concentrations of 10-6M and 10-3.5M respectively.Conclusions: The amplitude of relaxation response to dipyridamole of all grafts samples were similar, without statistically significant difference among the IMA, RA and SV grafts in the in vitro tissue bath system. These results prove that dipyridamole has a potential use as a vasodilatatory drug in all graft types.
Salivary gland stones most frequently arise from the submandibular salivary gland. A giant stone is not common, since its diagnosis and treatment is usually performed before the lesion becomes enlarged. A male patient referred to our clinic with complaints of painful neck swelling, trismus and dysphasia. The patient was hospitalized with the diagnosis of deep neck infection, and antibiotherapy was initiated. Computerized tomographic evaluation showed an opacity in the first neck region. The patient was operated on under general anesthesia, and the cause of the opacity was a sialolith that reached dimensions of 4x2x1.5 cm, leading to extreme dilatation of Wharton's duct.
Objective: This study was planned to investigate the therapeutic efficacy of terbinafine and interaction between terbinafine with amphotericin B, and fluconazole on candidiasis in a mouse model.Material and Methods: Treatment with amphotericin B (1mg/kg/day intraperitoneally), fluconazole (100 mg/kg/day ip), terbinafine (100 mg/kg/day by oral gavage) and combinations of terbinafine with amphotericin B and terbinafine with fluconazole at the same doses began 24 h after infection and continued for 10 days, and kidney cultures were performed.Results: No significant improvement in survival was not found between the control and the terbinafine group (p>0.05). With the addition of amphotericin B to terbinafine, significant improvement in survival was found compared with the survival of untreated controls (p<0.0001). When compared with the control group, the kidney culture results of the amphotericin B group were superior to those with two-fold reduction in CFU counts (p<0.05), but the difference between the terbinafine group and the control group was not significant (p>0.05). Terbinafine with amphotericin B and terbinafine with fluconazole combinations, when compared by fungal density reduction with amphotericin B, were less effective and the difference was significant (p<0.0001).Conclusion: Terbinafine had no effect on controlling systemic candidiasis alone and a slight effect in combination with amphotericin B and fluconazole.
On May 15, 2009, the Turkish Ministry of Health reported the first case of 2009 pandemic influenza A (H1N1) virus infection in the Republic of Turkey. Pandemic H1N1virus is a new and mutant influenza virus and has many epidemiologic and clinic features. These cases have been reported in multiple geographic regions of the world. School children are more affected than adults. In the elderly, it has a higher mortality rate. The clinical aspects of infection with H1N1 influenza A virus remains to be understood. A few cases of pulmonary embolism associated with H1N1 influenza A virus infection were reported. We herein report a pulmonary embolism in a patient with pandemic influenza A (H1N1) virus infection. A 42-year-old Turkish woman was admitted to our emergency department with dyspnea and pleuritic chest pain. She complained of fever, myalgia, sore throat and cough of four days duration on admission to our hospital. She was tested for pandemic influenza A (H1N1) virus by a polymerase chain reaction (PCR) test which revealed a positive result. Chest tomography showed pulmonary embolism. She was successfully treated with intravenous heparin and oseltamivir. This case report demonstrates the importance of considering pulmvonary embolism as a diagnosis in 2009 pandemic influenza A (H1N1) virus infected persons who present with sudden onset of dyspnea, fever and chest pain.
Objective: The purpose of this study is to evaluate the effect of various upper extremity positions (adduction-abduction) on vascular structures in contrast-enhanced three-dimensional MR angiographic studies performed in patients with thoracic outlet syndrome.Materials and Methods: Twenty-two consecutive patients with clinical symptoms of neurovascular thoracic outlet syndrome were examined by 1.0 T MR unit. Examinations were studied by three-dimensional contrast-enhanced MR angiography with the arms positioned in abduction and adduction in the same patients.Results: In twenty-one of 44 subclavian arteries, impingement or stenosis with different degrees were found. Majority of lesions were localized in the costoclavicular region. Venous phase sequences of contrast-enhanced MR angiography showed compression of the subclavian vein in the 17 areas.Conclusion: Thoracic outlet syndrome remains controversial in both diagnosis and treatment, particulary in patients with no muscle atrophy, hand ischemia findings or venous stasis symptoms. Three-dimensional contrast-enhanced MR angiography is noninvasive and requires neither ionizing radiation nor administration of iodinated contrast material- and may be used to diagnose early compression findings and stenosis of the subclavian vessels.
Pleuropulmonary blastoma is a malignant lung tumor affecting children. Pleuropulmonary blastoma is a rare entity having an incidence between 0.25-0.5% of all primary lung malignancies that occurs exclusively in children younger than 6 years. The tumor usually originates from pulmonary parenchyma, mediastin and pleura and especially presents as a solitary pulmonary mass in unilateral lung. In this case report, we present a 3.5-year-old boy who was admitted with fever, dyspnea, wheezing, abdominal pain, weight loss and was diagnosed as pleuropulmonary blastoma. As pleuropulmonary blastoma is rarely seen in childhood, relevant literature on pleuropulmonary blastoma is reviewed.
Ectopic secretion of adrenocorticotropic hormone (ACTH) related Cushing's syndrome (CS) is more frequently observed than many other paraneoplastic syndromes in patients with small cell lung cancer. Suppression of the cellular immune system in these patients is severe problem for both patients and physicians. In addition, the chemotherapy has been caused to severity and higher rate of hematological toxicity. We present a case of small cell lung cancer having a very poor prognosis, with a compressed humoral and cellular immune system due to an ectopic secretion of ACTH related CS. We report a rare case of combined immunosuppression in a case with small cell lung cancer in this paper. In addition, in the light of this special case and literature, we suggest treatment strategies for small cell lung cancer patients with CS.
