N-Acetylcysteine in the treatment of trichotillomania: remarkable results in two patients.

BACKGROUND: The management of trichotillomania is challenging. The limited efficacy and side-effects of pharmacological medications and difficulty in long-term maintenance of behavioural therapies necessitates alternative treatment options. A dysregulated glutamatergic system has been implicated in the pathophysiology of trichotillomania. A limited number of reports indicate that N-acetylcysteine (NAC), a glutamate modulator, may be a promising treatment for this disorder. OBJECTIVES: We report two patients with trichotillomania for whom treatment with NAC was successful. METHODS: The first patient was a 30-year-old female, and the second patient was a 14-year-old girl, both who were diagnosed with trichotillomania and prescribed NAC (1200 mg/d, p.o.). RESULTS: Hair pulling behaviour subsided within 2 months and 2 weeks of initiating NAC in the first and second patient, respectively. Complete hair regrowth was observed after 4 and 6 months of NAC treatment in the first and second patient, respectively. No side-effects related to NAC were noted. CONCLUSION: NAC could be a well-tolerated and effective treatment option for trichotillomania.

Relationship between nurses' practice environments and nursing outcomes in Turkey.

AIM: This study aimed to understand nursing practice environment characteristics in Istanbul-area hospitals in Turkey, the relationship between these characteristics, nurse burnout levels and nurses' intentions to leave work. BACKGROUND: A well-known relationship exists in many countries between nursing practice environments and nurse burnout and intention to leave work. However, little is known about the relationship between practice environment characteristics and nursing outcomes in Turkey. METHODS: This cross-sectional study was conducted among 2592 nurses in 20 Ministry of Health and 29 private hospitals in Istanbul, Turkey. A demographic questionnaire, Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory were used for data collection. RESULTS: Almost half of nurses suffered from high-level burnout related to emotional exhaustion and personal accomplishment, and one-third reported depersonalization and the intent to leave their jobs within a year. A poor nursing practice environment was the leading factor, increasing nurses' burnout levels in all subdimensions. Burnout related to emotional exhaustion, personal accomplishment and poor practice environment increased intention to leave. Permanent positions decreased intention. DISCUSSION: There was a relationship between poor practice environments and nursing outcomes in Turkey. LIMITATIONS: The use of a survey data collection method is a potential study limitation. Quantitative and qualitative methods could be combined to obtain more detailed objective data about nursing practice environments. CONCLUSION: Poor practice environments, high-level burnout and intention to leave work are significant problems in Istanbul, Turkey. Favourable practice environments and job security should be provided to improve nursing outcomes. IMPLICATIONS FOR NURSING POLICY: Policymakers and nurse managers should be aware of any negative issues regarding nursing practice environments and job security to improve nursing outcomes.

Vertical vs. transverse sections of scalp biopsy specimens: a pilot study on the comparison of the diagnostic value of two techniques in alopecia.

BACKGROUND: Using both vertical and transverse sections is preferred for histopathological diagnosis of alopecia. However, in cases in which only a single biopsy is taken, it is not clear which type of sectioning is better. AIM: To compare the diagnostic value of transverse and vertical sections. METHODS: In total, 53 patients with alopecia were enrolled in the study. Two biopsies were taken from each patient, and cut into either transverse or vertical sections. The clinical and histopathological findings were evaluated together for the definitive diagnosis. After the study period, a pathologist randomly re-evaluated the sections. We compared the histopathological diagnoses with the definitive diagnoses, and determined the sensitivity and specificity of each method. RESULTS: A definitive diagnosis was made for 47 patients (88.7%). Of these, 30 (63.8%) had noncicatricial and 17 (36.2%) had cicatricial alopecia, and the diagnosis was made by transverse and vertical sections for 43 (91.5%) and 39 (88%), respectively (P > 0.05; sensitivity; 91.5% vs. 82%). All 30 patients with noncicatricial alopecia were diagnosed by transverse sections, and 25 (83.3%) of the 30 were diagnosed with vertical sections (P = 0.05; sensitivity 100% vs. 83.3%). Of the 17 patients with cicatricial alopecia, 13 (76.5%) and 14 (82.4%) patients were diagnosed by transverse and vertical sections, respectively (P > 0.05; sensitivity 76.5% vs. 82.4%). Five patients with lichen planopilaris were diagnosed by vertical sections, and one by transverse sections. There were several limitations to the study: (i) statistical subtype analysis could be performed only for alopecia areata; (ii) no conclusion could be drawn about the interobserver reliability of two sections; and (iii) having the pathologist-blinded study performed retrospectively might have caused a recall bias. CONCLUSION: If only a single biopsy specimen is available, it may be preferable to have transverse sections in cases of suspected noncicatricial alopecia, and vertical sections in cases of suspected lichen planopilaris. Either type of sectioning is suitable for cicatricial alopecia when lichen planopilaris is clinically unlikely.

Lung carcinoma metastasis presenting as a pineal region tumor.

The pineal region is an unusual site for brain metastasis and most metastatic pineal lesions are asymptomatic. A 53 year-old man presented with severe headache, limitation of upward gaze and diplopia. The patient's neurological examination was unremarkable. Magnetic resonance imaging (MRI) scans of the brain demonstrated a 1.5 x 2 cm well demarcated solitary mass in the pineal region with hydrocephalus. Surgery was performed and adenocarcinoma was diagnosed. A systemic investigation revealed adenocarcinoma of the lung as primary lesion. Although rare, metastatic tumor should be considered in the differential diagnosis of pineal region tumors.

In vitro antifungal susceptibility of dermatophyte strains causing tinea pedis and onychomycosis in patients with non-insulin-dependent diabetes mellitus: a case-control study.

BACKGROUND: The efficacy of antifungal treatment may be reduced and/or delayed in diabetic patients. To date, no study has investigated the in vitro antifungal susceptibility of dermatophytes in this patient group. OBJECTIVE: We aimed to determine the dermatophyte species causing tinea pedis and onychomycosis, and in vitro susceptibility of these dermatophytes to terbinafine, itraconazole, and fluconazole in patients with non-insulin-dependent diabetes mellitus. We compared the findings in diabetic patients with those in non-diabetic individuals. MATERIALS AND METHODS: One hundred patients with non-insulin-dependent diabetes mellitus and 100 otherwise healthy controls clinically suspected with tinea pedis and/or onychomycosis were included. Skin scrapings and/or nail clippings were taken and cultured on Sabouraud dextrose agar, mycobiotic agar, and dermatophyte test medium. In vitro antifungal susceptibility tests were carried out according to the Clinical and Laboratory Standards Institute (CLSI) M-38P protocol with some modifications. RESULTS: Fifty-seven samples of 54 diabetics and 50 samples of 50 controls grew dermatophytes. In both groups, Trichophyton rubrum was the most common isolate. Mean MIC values of terbinafine, itraconazole, and fluconazole for all of the isolated dermatophyte strains were similar in two groups (P>0.05). The difference in mean MIC values of three antifungals for T. rubrum and T. mentagrophytes between two groups was not statistically significant (P>0.05). CONCLUSIONS: Dermatophyte types causing tinea pedis and onychomycosis, their frequency patterns, and in vitro activity of three antifungals against dermatophytes in diabetics are similar to the non-diabetics. Terbinafine is the most active agent in vitro in both groups.

Ovarian metastasis of a primary renal cell carcinoma: case report and review of literature.

Ovarian metastases from renal cell carcinoma (RCC) are very rare, with only 23 cases reported in the literature. We report a case of 54-year-old women who developed bilateral ovarian metastasis 39 months after diagnosis of clear cell carcinoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. Subsequently she was treated with sunitinib and her disease stabilized. She is still alive four years after diagnosis of the renal primary, and disease has stabilized on sunitinib. We conclude that, although rare, the possibility of metastatic RCC should be considered in the differential diagnosis of clear cell tumors of the ovary. Due to therapeutic and prognostic implications, it is very important to differentiate if the tumor is a primary ovarian tumor or a metastasis from a renal cell carcinoma. Early diagnosis of this rare metastatic tumor results in prompt treatment and prolonged patient survival.

Primary carcinoid tumor arising in a mature cystic teratoma of the ovary: a case report.

OBJECTIVE: To present an extremely rare case of a primary carcinoid tumor arising in a mature cystic teratoma of the ovary. Malignant transformation of mature cystic teratoma is an uncommon complication occuring in approximately 1-3% of patients with mature cystic teratoma. CLINICAL PRESENTATION AND INTERVENTION: A 54-year-old woman presented with abdominal swelling and abnormal uterine bleeding. Physical examination revealed a smooth, non-painful, 8-9 cm diameter mass in the right anterior pelvis which was diagnosed histologically as carcinoid tumor arising in a mature cystic teratoma. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and was scheduled for surveillance CT of the abdomen and pelvis at 3-monthly intervals. CONCLUSION: This case adds to the rare reports in the literature of a carcinoid of low malignant potential occurring in a mature cystic teratoma. The treatment for early-stage ovarian carcinoid tumors confined to one ovary is surgery alone and excellent outcomes can be expected in these cases.

Is Ultrasonography a Useful Method to Evaluate the Effectiveness of Complex Decongestive Therapy in Breast Cancer-related Lymphedema?

In recent years the use of ultrasonography has become widespread in the field of lymphedema especially as an aid for diagnosis. The aim of this study was to evaluate whether ultrasonography is a useful method to assess the efficacy of complex decongestive therapy (CDT). Circumferences and ultrasonographic evaluations (cutis and subcutis thickness) were performed at 10 cm proximal and distal to the elbow and limb volume (upper and forearm) was calculated from circumferences at six anatomic landmarks by using truncated cone formula. Measurements were recorded before and after CDT on both sides. A total of twenty-six women (mean age 51.3 ± 10.8) with the diagnosis of breast cancer-related lymphedema (BCRL) were enrolled in the study. Significant reduction in the subcutis thickness was observed on the affected side after the treatment period, and the percentage change in subcutis thickness was correlated with the percentage change in edema. This study also demonstrated that the soft tissue thickness was higher in the affected arm and ultrasonographic findings were consistent with the other measurement methods (circumferences and limb volumes). Considering that ultrasound imaging is patient-friendly, non-invasive, and cost-effective, we recommend its more widespread use for evaluating treatment efficacy in BCRL.

Malignant Leydig cell tumour of the testis: a case report and review of the literature.

A rare case of malignant Leydig cell tumour of the testis is presented. There was no standard therapy regimen. Leydig cell carcinoma is relatively refractory to radiotherapy and chemotherapy. So a retroperitoneal node dissection should be performed before or after chemotherapy for staging and also for therapeutic reasons.

Primary lymphoma of the trigeminal nerve.

Although malignant lymphoma of the central nervous system (CNS) is rarely seen, its frequency is increasing as a result of more common observation of immunocompromised patients. Primary CNS lymphoma arise usually in the white matter of brain and account for only 0.5-1.5% of all primary brain tumours. However, skull base and cranial nerve lymphomas are extremely rare. We present here the third primary lymphoma of the trigeminal nerve in the literature.