Proton MRS in Behçet's disease with and without neurological findings.

Our aim was to investigate whether neurological impairment in Behçet's disease (BD) can be assessed by means of proton MRS and whether it can assist in prognosis. We used single-voxel MRS to measure metabolites in regions of normal-appearing pons, basal ganglia and periventricular white matter (PWM) in 32 patients with chronic BD patients with and without neurological deficits and 29 control subjects. Patients had significantly higher N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios in the basal ganglia than the controls. The Cho/Cr ratio in the PWM was also significantly higher in the patients. MRS enabled clear discrimination of patients and controls and also revealed spectral differences between non-neuro-Behçet's disease and neuro-Behçet's disease in the basal ganglia. MRS can be used to assess brain involvement in BD even if structural changes are absent.

Increased plasma adrenomedullin levels in patients with Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a chronic systemic inflammatory disorder affecting multiple organs with a generalized vasculitis of arteries and veins. Endothelial dysfunction is one of the prominent features of BD. Adrenomedullin (AM) is a peptide produced not only in normal adrenal medulla but also in the vascular smooth muscle cells and endothelial cells, and its role in the course of BD has not been previously described. OBJECTIVE: To detect changes of plasma AM concentrations in patients with BD compared with age- and sex-matched healthy subjects by using high-performance liquid chromatography (HPCL). We also investigated if disease activity or the duration of BD correlates with AM levels. METHODS: Forty-two consecutive patients with BD (38.5 +/- 11.1 years, 19 male and 23 female) and 20 healthy age- and sex-matched control subjects (39.5 +/- 10.9 years, 8 male and 12 female) were included in this study. We measured plasma AM levels by HPCL, and acute-phase reactants including alpha(1)-antitrypsin and alpha(2)-macroglobulin, neutrophil count and the erythrocyte sedimentation rate. RESULTS: Mean +/- SD plasma AM levels in patients with BD (73.22 +/- 25.55 pmol/l) were significantly higher (p < 0.001) than in healthy control volunteers (21.35 +/- 12.37 pmol/l). Patients with active BD had similar plasma AM concentrations (79.32 +/- 21.89 pmol/l) with patients with inactive disease (67.44 +/- 29.92 pmol/l). On the other hand, patients with longer duration of the disease (mean duration, 13.9 +/- 3.8 years) had significantly higher plasma AM levels (83.99 +/- 19.71 pmol/l; p = 0.005) than patients (62.45 +/- 26.57 pmol/l) with shorter duration of the disease (mean duration, 5. 5 +/- 2.3 years). All acute-phase reaction parameters were found to be significantly increased in the active disease. CONCLUSION: Considering its endothelial cell implications, AM may be involved in reparatory vessel endothelium mechanisms, especially in the chronic disease.

Three cases of verrucous carcinoma.

Verrucous carcinoma of the skin and mucosa is an uncommon clinicopathological variant of low grade squamous cell carcinoma. Here, we present three different clinical types of verrucous carcinoma. The first patient presented with an anogenital verrucous carcinoma, also known as Buschke-Loewenstein tumour. The second patient had verrucous carcinoma of the heel with endophytic growth (i.e. epithelioma cuniculatum) and the third patient had gluteal verrucous carcinoma with a cauliflower-like appearance. Clinically, the lesion of the first patient best resembled giant condyloma accuminatum without any prominent verrucous component, whereas the second patient showed a big deep ulcer on the heel. None of the patients had metastasis. The diagnosis was confirmed with biopsy and total excision was performed in all cases. Although the cases have different clinical presentations in different locations, we think that they should be considered as a single entity; that is, verrucous carcinoma.

Bilateral inflammatory linear verrucous epidermal nevus associated with psoriasis.

Inflammatory linear verrucous epidermal nevus is a benign hyperplasia of the epidermis. Bilateral distribution of inflammatory linear verrucous epidermal nevus is an extremely rare presentation. Although inflammatory linear verrucous epidermal nevus is generally accepted as a distinct entity, it has similar clinical and histopathologic features to psoriasis, or they occasionally may overlap. We report the case of an 8-year-old boy with bilateral inflammatory linear verrucous epidermal nevus who also had psoriasis.