Short-term effects of montelukast in stable patients with moderate to severe COPD.

This study aims to investigate the possibility of additional value of leukotriene receptor antagonist (LTA) on dyspnea score, arterial blood gases (ABG), pulmonary function tests (PFTs), and quality of life (St. George QoL) in chronic obstructive pulmonary disease (COPD) patients. In this randomized, prospective, single-blind, and controlled study, 117 non-reversible COPD patients defined by global initiative for chronic obstructive lung disease (GOLD) criteria were randomized to receive ipratropium bromide, formoterol and montelukast (n:58, montelukast group) or ipratropium bromide and formoterol (n:59, control group) after a 2-week run-in period. There was no significant demographic difference between the two groups (P>0.05). Baseline ABG, PFT, visual analoque scores (VAS), and QoL scores were obtained and at first month and second month, PFT, VAS, and QoL scores were repeated and ABG was obtained at second month and the values were compared with baseline values. As the result of the comparison, there was significant increase in vital capacity, FVC, FEV1, VAS, and PaO2 parameters (P<0.05), and a significant decrease in the QoL scores (P<0.05) in the montelukast group. These parameters did not show any difference in the control group (P>0.05). Sputum samples that could be obtained in 24 of the COPD patients were evaluated and in the montelukast group, there was a decrease in neutrophilic activity after treatment (n:13) (P:0.059). These results suggest that LTA that is used additionally in routine treatment protocol can produce additive improvement on PFT, dyspnea score and especially QoL in patients with stable COPD and for these reasons, LTA may be taken into account when there is need for an additional anti-inflammatory treatment in COPD patients.

Cyclic lymphocytic vasculitis associated with chronic lymphocytic leukemia.

Lymphocytic cutaneous vasculitis associated with a haematological malignancy has rarely been reported. Here, we describe a 61 year-old woman with chronic lymphocytic leukemia (CLL) who presented with cutaneous lesions on both hands. These lesions improved after all combination chemotherapy courses and recurred before each course. Repetitive skin biopsies revealed lymphocytic vasculitis. After 7 courses of chemotherapy, she had a complete remission. Skin lesions disappeared and did not recur. The cyclic pattern of lymphocytic vasculitis and its relation with CLL disease activity are interesting clinical features in this case.

Palmoplantar lichen planus presenting with vesicle-like papules.

Palmoplantar lichen planus is a rare, localized variant of the disease that may create difficulty in diagnosis if it is present as an isolated finding. Although several morphological patterns may be seen, plaques or small papules with compact hyperkeratosis are usually observed. We present a 25-year-old woman with a one-month history of slightly pruritic, red papules on her palms and soles. Dermatologic examination revealed numerous, asymptomatic, unscaly, red papules on her palms and soles, some of them resembling vesicles and white reticulate plaques on both sides of the buccal mucosa. The diagnosis was established by the typical histopathological features of lichen planus. Although resistant to topical corticosteroids, she responded well to systemic corticosteroid therapy, and no recurrence was observed during the follow-up period of one year.

Wolf's isotopic response: a case of zosteriform lichen planus.

Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25-year-old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out-patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response.

Erythromelanosis follicularis faciei et colli associated with keratosis pilaris in two brothers.

Erythromelanosis follicularis faciei et colli is characterized by well-demarcated erythema, hyperpigmentation, and follicular papules. Since the original description, it has seldom been reported in the literature. We present two adolescent brothers who had this disorder associated with keratosis pilaris on the shoulders and the extensor surfaces of the arms. Dermatologic examination found brown-red pigmentation, erythema, and follicular papules on both maxillary, preauricular regions, and the cheeks. The lesions of the older brother were more prominent. Histopathologic examination of skin biopsy specimens taken from both brothers revealed hyperpigmentation of the basal layer, follicular plugging, dermal vascular dilatation and congestion, and perivascular inflammatory infiltration. We suggest that the coexistence of these two conditions in brothers implies a genetic inheritance and a possible relationship between the disorders.

Needle-guided shave excision with ultrasonographic assistance: a new technique.

BACKGROUND: A lack of control in the deep margin of shave excision is a drawback of this technique. OBJECTIVE: To describe a more precise shaving technique by sonography with the use of a fine injector needle as a depth marker. METHODS: After having examined the invasion levels of 40 benign skin lesions, a fine injector needle was intentionally threaded into the dermis horizontally just beneath the required shaving plane. Correct placement of the needle was ensured by sonographic examination after possible reinsertion trials. Large lesions needed several needles to be inserted. The tissue above the needles was then shaved off, whereas the deep dermal layer was protected. RESULTS: Histologic examination revealed that 77% of superficial and intermediate-thickness lesions were removed totally without disturbing the derma-fat junction. CONCLUSION: The needle-guided technique was found to be effective in the control of the deep margin of shave excision.

Does high-pressure carbon dioxide insufflation facilitate mucosal dissection in transanal endorectal pull-through? A rabbit model.

The aim of the present study was to investigate whether high-pressure carbon dioxide insufflation facilitates mucosal dissection in the transanal endorectal pull-through (TEPT) operation performed in Hirschsprung's disease in a rabbit model. In the study, ten New Zealand rabbits were used. In six of the rabbits, CO(2) under 50 mmHg pressure was insufflated into the submucosal area through a 25-gauge scalp needle inserted 0.3 cm over the dentate line. Two of the rabbits were taken for histopathological examination. In four rabbits, the TEPT operation was performed and in another four the operation was performed without CO(2) insufflation. Histopathological examination in the CO(2)-insufflated group of rabbits showed that at transversal incisions mucosa was seen to be separated circumferentially from submucosa by high pressure CO(2) and at longitudinal incision the separation was seen to be complete along the anal canal. It was noted that mucosal dissection was rapid, non-bloody and without induced mucosal tears or perforation; however, in the non-insufflated group the operation was time-consuming, bloody and more difficult to perform and needed meticulous care. In the present study, it was seen that submucosal high pressure CO(2) insufflation in rabbits facilitates mucosal dissection in the TEPT operation and is easy to perform, time-saving and highly economical.

Bullous pemphigoid associated with prostate adenocarcinoma.

Bullous pemphigoid is a common autoimmune skin disease characterized by the presence of subepidermal blisters. It has been associated with underlying neoplasia in isolated reports. A 78-year-old man with generalized blisters was diagnosed as bullous pemphigoid on clinical, histopathological and direct immunofluorescence grounds. His free and total prostate specific antigen (PSA) levels were high and histopathological examination of a prostate specimen revealed prostate adenocarcinoma. We present this rare case to discuss the possible association between bullous pemphigoid and prostate adenocarcinoma.

Effect of adhesion barrier (Interceed TC7) on two-stage orchidopexy operation.

OBJECTIVE: In two-stage orchidopexy, adhesions formed after the first stage usually cause difficulty during the second operation and may even lead to injury to the testis itself or to the spermatic cord. We investigated whether the use of adhesion-preventing barriers in the abdominal or pelvic region during surgery could lessen adhesions formed during two-stage orchidopexy and thus ease dissection. MATERIAL AND METHODS: The study subjects comprised 21 male, albino, 30-day-old Wistar rats that were divided into three equal groups. In Group 1, the right testes were enveloped in adhesion barriers after dissection and sutured to the inguinal canal. In Group 2, the right testes were sutured to the inguinal canal without the barriers. In Group 3 (sham-operated group), all testes were dissected but no suturing was performed. Rats were sacrificed after 21 days and the ipsilateral testes were harvested. RESULTS: Dissection of barrier-enveloped testes was relatively easy; however, no significant (p < 0.535) difference was seen in adhesion scores between Groups 1 and 2. Total tissue collagen was estimated by means of the hydroxyproline content. Tissue hydroxyproline levels were 16.04 +/- 8.58, 13.20 +/- 6.34 and 14.71 +/- 5.51 microg/mg wet tissue in Groups 1-3, respectively and these differences were not significant. The histopathologic evaluation revealed significant differences only in the thickness of the tunica albuginea in Groups 1 and 2 (110.0 +/- 30.0 vs 77.1 +/- 21.3 microm, respectively; p < 0.038). CONCLUSION: The adhesion scores and the biochemical and histopathological examinations showed that an adhesion barrier is not beneficial in two-stage orchidopexy.