A case of methotrexate intoxication in a patient with psoriasis who drank beetroot juice during methotrexate treatment.

Methotrexate is extensively used in the treatment of psoriasis. Although safe and effective, its use may inadvertently lead to intoxication. We report a 50-year-old woman being treated with methotrexate for psoriasis who developed methotrexate intoxication after drinking beetroot juice as a herbal remedy. Patients should be warned about the potential adverse effects of herbal therapies during methotrexate treatment.

Demographical, laboratory and associated findings in patients with perniosis.

BACKGROUND: Perniosis is a cold-induced inflammatory disorder of the acral areas. The objective of this study was to investigate the demographic characteristics, associated factors, clinical and laboratory findings in patients with perniosis and to compare those findings between patients who had recurrent and acute disease. METHODS: Thirty-four patients with perniosis were investigated retrospectively for age, gender, occupation, smoking and diet histories, associated diseases, family history of perniosis, precipitating factors, the month of onset and the duration of perniosis, the distribution of the lesions and the results of laboratory investigations. RESULTS: Fifteen patients were male and 19 were female. The ages of the patients ranged from 15 to 57 years. Thirteen patients were working as sales people, which was the most common occupation. Sixteen patients were smokers. While 25 of the patients had encountered perniosis for the first time, in 9 of the patients, there were recurrent lesions. Diseases other than perniosis were recorded in 6 of the patients. The laboratory tests revealed mild leukopenia in 2, antinuclear antibody (ANA) positivity in 3, mild rise in albumin level in serum protein electrophoresis in 1 patient. ANA positivity was significantly higher in patients with recurrent disease. CONCLUSION: Perniosis was more common in women and below 40 years. We found no significant laboratory findings except ANA positivity in patients with recurrent perniosis.

Giant congenital melanocytic naevus associated with Dandy-Walker malformation, lipomatosis and hemihypertrophy of the leg.

A 30-year-old woman presented with congenital hyperpigmented plaques and multiple tumoral lesions. Her left leg was hypertrophic, although the bones were normal. Dermatological examination revealed hyperpigmented macules and plaques with hair on the legs, abdominal and lumbar areas (covering > 60% of the total body surface) and multiple naevi on the face, arms, back and chest. Multiple soft masses of various sizes, some of which colocalized with hyperpigmented plaques, were seen on the trunk and legs. Malignant melanoma was excluded by histopathological examinations of multiple biopsy specimens obtained from the pigmented lesions. Histopathological examination of one of the soft masses showed that it was a lipoma. Cranial magnetic resonance imaging and computed tomography scans showed an enlarged fourth ventricule and vermis hypoplasia (Dandy-Walker malformation; DWM). Neurocutaneous melanosis is a rare combined abnormality of the skin and central nervous system. A few case reports relating to the coexistence of giant congenital melanocytic naevus, lipomatosis and hemihypertrophy have been published in the literature. We report this very rare case of giant melanocytic naevus with lipomatosis, hemihypertrophy of the leg, and DWM.

Homocysteine, vitamin B12 and folic acid levels in psoriasis patients.

BACKGROUND: Hyperhomocysteinaemia is a risk factor for atherosclerotic cardiovascular disease, stroke, peripheral arterial occlusive disease and venous thrombosis. An association between psoriasis and cardiovascular diseases has been reported. AIM: The aim of our study was to examine serum homocysteine, folic acid and vitamin B12 levels in psoriasis patients. MATERIAL AND METHODS: We performed a cross-sectional study in 70 consecutive outpatients with chronic plaque psoriasis and 70 age- and gender-matched controls. Serum levels of homocysteine, vitamin B12 and folic acid levels were measured in both groups. RESULTS: Serum homocysteine, folic acid and vitamin B12 levels did not differ between patient and control groups. In psoriasis patients, homocysteine levels correlated directly with psoriasis severity as measured by psoriasis area and severity index. Serum homocysteine level inversely correlated with serum folic acid levels in the patient group. DISCUSSION: Homocysteine levels correlated with psoriasis area and severity index in the patient group, which shows the disease severity. The increase in cardiovascular mortality with the severity of psoriasis might be also due to the effects of homocysteine.

Changing cerebral blood flow velocity detected by transcranial Doppler ultrasound during head up tilt in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a chronic inflammatory disease of central nervous system. We aimed to investigate the cerebral blood flow velocity (CBFV) changes in MS by transcranial Doppler. METHODS: Twenty patients with MS, 20 age-matched healthy controls were included in the study. In both groups, blood flow velocities (BFVs) of middle cerebral arteries (MCAs) were evaluated. The changes of blood pressure, heart rate along with the changes in BFV of MCA were recorded after the patients were raised to upright position. RESULTS: In both groups, upon raising the tilt table to the upright position, the mean CBFV values were found to be lower in comparison with the recorded baseline values (P values <0.05). The decline in the mean CBFV values was more significant in patients with MS (P = 0.01). CONCLUSION: Our study showed upon raise of the tilt table, the mean BFVs decreased more in MS patients than control group with a more prominent change in the subgroup of MS patients with expanded disability scale scores > or =2. By use of transcranial Doppler ultrasound, it may be possible to evaluate BFV changes in patients with MS.

Statin therapy and diabetic skin.

PURPOSE: Statins are widely used drugs for reducing cholesterol levels. The aim of this study was to observe the effects of statin therapy on skin histopathology in both normal and diabetic mice. METHODS: 45 Swiss albino mice were studied in 4 sub-groups: control, statin-treated control, diabetic, and statin-treated diabetic. The first group was diabetic-induced with 250 mg/kg of streptozosin administered intravenously. The second group served as the control. Four weeks after streptozosin injection, both diabetic and control groups were divided into 2 sub-groups and 1 mg/kg/d simvastatin was injected for 14 d intraperitoneally to form the statin-treated control and statin-treated diabetic groups. The remaining 2 groups formed the untreated control and untreated diabetic groups. Histopathological examination of the skin was made with haematoxylin eosin staining under a light microscope. RESULTS: There was no apparent difference between the groups in epidermal thickness, proliferative activity, dermal thickness and composition. Cystic dilatations in the infundibulum of hair follicles with distorted and smaller sebaceous glands were seen in the statin-treated control, diabetic, and statin-treated diabetic groups. CONCLUSION: We conclude that there is altered lipid synthesis in the sebaceous glands in both diabetic and statin-treated groups.

Cervical lipomyelomeningocele: case illustration.

Cervical lipomyelomeningocele is a rare congenital spinal pathology. Lipomyelomeningocele is the commonest cause of congenital tethering, which causes neurological deterioration due to the conus medullaris and root ischemia. Early intervention is recommended even in cases with normal neurological examinations in order to prevent deterioration but our patient with cervical lipomyelomeningocele had a normal neurological examination despite his age (22 year-old) and had no urodynamic dysfunction.

Cervical lipomyelomeningocele: case Illustration

El lipomielomeningocele cervical es una patología raquídea congénita rara. El lipomielo meningocele es la causa más frecuente de anclaje medular, que da lugar a deterioro neurológico, debido a isquemia del cono medular y de las raíces. Se recomienda la intervención precoz, incluso en casos con examen neurológico normal, con el fin de prevenir un deterioro, pero nuestro paciente con lipomielomeningo cele cervical tenía un examen neurológico normal, a pesar de su edad (22 años) y no tenía ninguna disfunción urinaria

Cervical lipomyelo meningocele is a rare congenital spinal pathology. Lipomyelo meningocele is the commonest cause of congenital tethering, which causes neurological deterioration due to the conus medullaris and root ischemia. Early intervention is recommended even in cases with normal neurological examinations in order to prevent deterioration but our patient with cervical lipomyelomeningocele had a normal neurological examination despite his age (22 year-old) and had nourodynamic dysfunction

Parry-Romberg syndrome in association with anti-dsDNA antibodies: a case report.

Parry-Romberg syndrome (PRS) is a rare and puzzling disorder that is characterized by progressive hemifacial atrophy. It involves mainly some or all tissues of one side of the face. A case of 21-year-old Caucasian man with hemifacial atrophy in the right facial region is reported. Serological studies with anti-single-stranded DNA (anti-ssDNA), anti-double-stranded DNA (anti-dsDNA), anticentromere (ACA) and antinuclear (ANA) antibodies were done. Anti-dsDNA antibodies was found positive, but the others were negative. Rheumatoid factor (RF) was also negative. Since PRS is rare and its association with anti-dsDNA antibodies was not reported before, this case appears to be the first report.

Craniocerebral gunshot wounds: results of less aggressive surgery and complications.

Four hundreds patients who suffered from cranial gunshot wounds injuries were analyzed. Surgical therapy, primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments were applied. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. In 130 of 400 patients, bone and metal fragments were determined on control CT scans. Most of the deaths in this group of patients were attributed to the influence of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scans. Surgery was not performed until the infection developed. Retained fragments did not increase the infection risk but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome. The prognostic importance of complications such as intracranial haemorrhage, epileptic seizures, hydrocephalus, was also investigated.