Elevated Tear Human Neutrophil Peptides 1-3, Human Beta Defensin-2 Levels and Conjunctival Cathelicidin LL-37 Gene Expression in Ocular Rosacea.

Purpose: To investigate the role of innate immunity in ocular rosacea. Methods: Thirty-two patients with ocular rosacea patients (group-1) and 28 healthy volunteers (group-2) who served as controls were enrolled in the study. Tear function parameters were assessed, conjunctival impression cytology was performed and tear samples were collected. Human-neutrophil-peptides (HNP) 1-3 and human-beta-defensin-2 (hBD-2) levels were measured in tears by using ELISA tests. Cathelicidin leucin-leucin-37 (LL-37), hBD-2, human-beta-defensin-9 (hBD-9) gene expression levels were measured in the conjunctival impression cytology samples using real-time polymerase chain reaction. Results: Tear HNP1-3 (p = 0.024), hBD-2 (p < 0.001), conjunctival LL-37 gene expression rate (p = 0.014) and ocular surface disease index scores (p = 0.001) were higher and the tear break-up time was lower (p = 0.003) in group-1. No other differences were found between the groups. Conclusion: The results of this study suggest the role of abnormal innate immunity in the pathophysiology of ocular rosacea by revealing elevated antimicrobial peptide levels.

Corneal and conjunctival sensitivity in rosacea patients.

PURPOSE: To assess corneal and conjunctival sensitivity in rosacea patients. METHODS: A total of 55 patients with rosacea and 37 control subjects participated in the study. Corneal and conjunctival sensitivity was determined by Cochet-Bonnet esthesiometer. Subjective symptoms of ocular dryness were evaluated using Ocular Surface Disease Index (OSDI). Schirmer's I test (ST), tear breakup time (tBUT) and ocular surface staining with fluorescein were carried out to measure objective signs. RESULTS: The mean corneal and conjunctival sensitivity did not differ significantly between rosacea patients and controls (all p > 0.05). Schirmer's I test and tBUT were significantly reduced (p = 0.004 for OD and p < 0.001 for OS) and grade of ocular surface staining was significantly high (p = 0.018 for OD and p = 0.038 for OS) in rosacea patients. Corneal and conjunctival sensitivity did not show significant correlation with ST, tBUT, ocular surface staining (Oxford Schema), duration of rosacea and OSDI score. CONCLUSIONS: Corneal and conjunctival sensitivity did not change significantly in rosacea.

A Complication in Hypospadias Surgery Due to Anchoring Suture.

The complication rates are still 1-90% both in proximal and distal hypospadias regardless of the surgeon's experience and the usage of most developed techniques. The literature survey revealed few complications of glans penis including meatal stenosis, prolapsus and retraction. Despite our literature survey, we could not find any article concerning the permanent scar tissue at the dorsal part of glans following hypospadias surgeries. A new complication can be added to these, concerning glans which is the formation of postoperative scar tissue as a reaction to suture material used in traction, stent anchoring or both. The aim of this paper is to demonstrate four cases which had glanular scar due to traction suture following the surgical procedures for hypospadias repair.

Markers of endothelial dysfunction and evaluation of vascular reactivity tests in Behçet disease.

We assessed endothelial dysfunction (ED) in patients with Behcet disease (BD; n=40) and healthy controls (n=20). Serum lipid, homocysteine, asymmetric dimethylarginine (ADMA) and high-sensitivity C-reactive protein (hsCRP) levels, erythrocyte sedimentation rates (ESRs), and ultrasonographic flow-mediated dilatation (FMD) were measured. Mean hsCRP, ESR, homocysteine, and ADMA were significantly higher in the BD group (P<.001 for all). Patients with active BD had higher serum levels of hsCRP, homocysteine, and ESR compared with those in remission (P<.001, P<.001, and P=.005, respectively). Flow-mediated dilatation was significantly lower in patients with BD than in controls (P=.001). Flow-mediated dilatation correlated negatively with BD duration and serum ADMA levels (P<.001, r=-.745 and P<.001, r=-.682); a positive correlation was seen between serum ADMA levels and BD duration (P<.001, r=.552). Only stepwise multivariate regression analysis revealed BD duration to have a significant effect on FMD. Flow-mediated dilatation, in conjunction with markers of inflammation, may evaluate ED in patients with BD.

Epithelial expression of extracellular matrix metalloproteinase inducer/CD147 and matrix metalloproteinase-2 in neoplasms and precursor lesions derived from cutaneous squamous cells: An immunohistochemical study.

Extracellular matrix metalloproteinase inducer (CD147) is a transmembrane glycoprotein involved in the regulation of matrix metalloproteinases (MMPs). The study investigated CD147 and MMP-2 expression in epidermis of cutaneous squamous lesions. CD147 and MMP-2 expressions were evaluated immunohistochemically in 44 specimens: 18 actinic keratoses (AK), 6 squamous cell carcinomas in situ (SCCIS), 13 squamous cell carcinomas (SCC; peritumoral and invasive portions assessed), and 7 normal skins. Patterns of expression were assessed, with MMP-2 in nuclei (MMP-2n) and cytoplasm (MMP-2c) evaluated separately. The expression of each marker was quantified using a calculated immunohistochemical/histologic score (H-score). Correlations were analyzed for the marker H-scores in each study group. Associations between H-scores and histopathologic parameters were also evaluated. CD147 H-score was the highest in SCC (invasive islands), followed by AK, SCCIS, and control specimens, respectively. MMP-2n and MMP-2c H-scores were the highest in AK, followed by SCCIS, SCC, and control specimens, respectively. MMP-2c and MMP-2n H-scores were significantly higher in peritumoral epidermis than in invasive islands of SCC. MMP-2c and CD147 H-scores were positively correlated in the peritumoral SCCs. CD147 H-score was positively correlated with tumor differentiation in SCC. The findings suggest that overexpression of CD147 plays a role in the development of SCC.

Scrotal pearl is not always a sign of anorectal malformation: median raphe cyst.

Pearls of meconium can be seen on the raphe of the scrotum and are considered as a sign of anorectal malformation (ARM). Scrotal pearls without ARM are rare in children and designated as median raphe cyst of the scrotum (MRC). A six-month-old boy with scrotal pearls without ARM is presented to discuss the clinical features and treatment modalities of MRC in infants.

Central corneal thickness in patients with mild to moderate rosacea.

OBJECTIVE: We aimed to evaluate central corneal thickness (CCT) in patients with rosacea in comparison to a healthy control group and to investigate any correlations by using the Schirmer test, tear break-up time (TBUT), and disease severity. DESIGN: Prospective nonrandomized study. PARTICIPANTS: Patients with mild to moderate rosacea (n = 51) and a group of healthy individuals (n = 51) were included. METHOD: Patients were evaluated by a dermatologist; disease severity was determined and total rosacea severity score was calculated for each patient. CCT measurements were performed using ultrasonic pachymetry. Tear function tests, including Schirmer and TBUT, were also performed. RESULTS: The mean CCT value was significantly lower in patients with rosacea than in the control group (544.91 ± 29.41 µm vs 559.40 ± 24.18 µm, p = 0.003). The mean Schirmer test value was significantly lower in patients than in controls (10.54 ± 6.09 mm vs 19.13 ± 4.24 mm, p < 0.0001), and the mean TBUT was shorter in the group with rosacea than in the controls (8.32 ± 3.50 s vs 16.67 ± 5.76 s, p < 0.0001). CCT values were found to be correlated with the Schirmer test values in the rosacea group (r = 0.33, p = 0.01). CONCLUSIONS: Patients with rosacea have thinner corneas, which could be attributed to the observed deteriorated tear function parameters. Candidates for corneal photoablation surgery should be evaluated regarding rosacea disease because the postoperative period could be complicated by decreased ocular wetting and corneal thinning, even in overlooked mild forms.

Cutaneous metastases of rectal mucinous adenocarcinoma mimicking granuloma inguinale.

A 46-year-old man complained of ulcerovegetative lesions in the anogenital region, which he had noted one month prior to presentation. The patient had a history of travel to African countries. Therefore, the ulcerovegetative lesions of the patient were suspected to be granuloma inguinale (GI). Calymmatobacterium granulomatis was not observed in the direct examination of scrapings collected from the base of the ulcerovegetative lesion. Instead, a histological examination revealed cutaneous metastasis of mucinous adenocarcinoma of the rectum. Therefore, a diagnosis of GI was eliminated. As the patient did not report his history of rectal cancer and had travelled to African countries, we had primarily focused on the diagnosis of GI.

Investigation of upper gastrointestinal tract involvement and H. pylori presence in lichen planus: a case-controlled study with endoscopic and histopathological findings.

BACKGROUND: Lichen planus (LP) is a common disease of unknown etiology. Rare mucosal involvements like esophageal LP have been reported increasingly. Infectious agents including H. pylori and other autoantigens have been investigated in etiology and association with certain gastrointestinal pathologies have been well documented. OBJECTIVES: The aim of this study is to investigate the upper gastrointestinal tract involvement in LP and to evaluate the possible etiologic role of H. pylori. PATIENTS, MATERIALS AND METHODS: 49 LP patients and 35 volunteers (without LP) with gastrointestinal symptoms were included in the study as the control group. LP group was divided into subgroups regarding gastrointestinal symptoms. Upper videoendoscopy was performed in both groups and biopsies were taken from suspicious areas for LP, gastrointestinal diseases, H. pylori and examined histopathologically. SPSS 13 was used for the analysis. Groups/subgroups were compared via xi-square test, Mann-Whitney U test, and t-test. RESULTS: Gastrointestinal symptoms were recorded in 71% of LP group; none of LP patients presented typical esophageal LP. Gastrointestinal diseases were more frequent in LP group than controls, endoscopically. Chronic gastritis (91.8%) was the leading diagnosis in LP patients. Superficial gastritis was significantly higher (13.3%) in LP patients than controls (p = 0.04). LP was not diagnosed in any of the esophageal mucosa biopsies whereas lymphoid follicles were observed significantly higher in control group (p < 0.01) histopathologically. H. pylori positivity was found higher in LP group (81.6%) though statistically insignificant. CONCLUSIONS: We believe upper endoscopy should be performed to investigate esophageal LP and gastrointestinal pathologies especially when LP patient is symptomatic. Although we didn't detect esophageal LP, our study had the limitation of taking biopsies from pathological sites only. Since histopathological examination of normal appearing esophagus may help in diagnosing occult LP, and prevent eventual complications, it may be further evaluated in larger study groups. A new technique, magnification chromoendoscopy, may be useful in detecting esophageal involvement. We believe the possible role of H. pylori in LP is yet to be determined also.

Assessment of ovarian stromal artery Doppler characteristics and serum hormone levels in patients with Behçet disease.

PURPOSE: The aim of the study was to examine serum hormone levels, ovarian volume, stromal artery Doppler parameters of patients with Behçet disease (BD) to assess whether there are vascular changes in the gonads of these patients. MATERIALS AND METHODS: Twenty patients with BD and 31 healthy controls aged between 18-45 years were examined in the early follicular phase of the menstrual cycle (day 2-3) with transvaginal ultrasound to evaluate ovarian volume and ovarian stromal artery Doppler parameters. On the same day, blood was drawn for determining serum hormone levels. RESULTS: Patients with BD and the controls were comparable with regard to age and body mass index at study inclusion. Although comparison of the ovarian stromal artery Doppler velocimetric parameters did not show significant differences, resistivity, pulsatility indexes and systolic/diastolic ratio were higher, while peak systolic and end diastolic velocities were lower, in BD patients compared to controls. The mean ovarian volume of patients with BD was smaller than the controls but this difference did not reach statistical significance. There were no statistically significant differences between serum hormone levels of either group. We did not find any correlations between hormone levels and mean ovarian stromal artery Doppler parameters of patients with BD. CONCLUSION: Ovarian stromal artery Doppler parameters of patients with BD did not show any significant differences compared to healthy controls. Therefore, we conclude that ovarian stromal artery is not involved in patients with BD as assessed by transvaginal Doppler ultrasound and serum hormone levels do not differ from the levels of healthy controls.

Expression of p53 in lesions and unaffected skin of patients with plaque-type and guttate psoriasis: a quantitative comparative study.

Psoriasis is a common inflammatory and hyperproliferative skin disease characterized by hyperproliferation of keratinocytes. The pathogenesis of psoriasis has yet to be determined. The control of cell growth is a delicately balanced process, regulated by external signals or the internal genetic program of an individual cell. In psoriasis, these processes are disturbed and some candidate genes like p53 are suspected of being involved in the pathogenesis of the disease. The p53 protein is essential for the regulation of cell proliferation. The study was performed on 32 patients with psoriasis (24 plaque type, eight guttate type). Biopsy specimens for immunohistochemical determination of p53 protein expression were collected from both the lesional and the nonlesional skin sites that were not exposed to sun in all of the patients (n = 32). Taking the ultraviolet (UV) exposure of the skin into consideration, a third skin sample was taken from each patient (n = 7) who had lesions on the sun-exposed areas. Immunohistochemical assessment of p53 expression in skin was determined as p53 protein expression per 1000 cells (keratinocytes). The statistical analysis revealed that the expressions of p53 per 1000 cells were higher in non-sun-exposed lesional skin than the non-sun-exposed nonlesional skin, also in plaque-type psoriasis than guttate-type psoriasis (P = 0.000, P = 0.046, P = 0.037, respectively). There was a positive correlation between the p53 expression in non-sun-exposed lesional skin versus expression in sun-exposed lesional skin (cubic centimeters = 0.811, P = 0.027). Our results show a stronger association of elevated p53 expression with chronic rather than acute inflammatory psoriasis. This may indicate a mechanistic difference between plaque-type and guttate psoriasis. Alternatively, this could reflect a chronological course as the disease transitions from an acute to a chronic phase.

Paraneoplastic acrokeratosis of Bazex (Bazex's syndrome): report of a female case associated with cholangiocarcinoma and review of the published work.

Paraneoplastic acrokeratosis of Bazex (PAB) or Bazex's syndrome is a rare, paraneoplastic syndrome that mostly affects men over 40 years old, and generally associates with squamous cell carcinoma of the upper aerodigestive tract. We describe a 57-year-old woman with the characteristic features of PAB, including violaceous erythematous, scaling eruption, palmoplantar keratoderma and nail dystrophy. Further analysis revealed the underlying neoplasm to be cholangiocarcinoma. The clinical aspects of PAB and associated neoplasms are reviewed.

Proteus syndrome with multiple genitourinary abnormalities.

Proteus syndrome is a rare hamartomatous disorder comprising a broad spectrum of congenital malformations and overgrowth of multiple tissues. Some rare urogenital malformations have been reported before. This case is unique for the presence of multiple genitourinary anomalies including retroperitoneal cystic mass, intra-abdominal testicle with hematoma and ureterovesical stricture apart from common clinic findings of proteus syndrome.

Debridement via collagenase application in two neonates.

Slow-healing wounds contain insufficient amounts of intrinsic collagenases to provide sufficient wound debridement, so that the use of products containing synergistic collagenases and proteases may be helpful. We report the successful use of collagenase clostridipeptidase A in two newborns, a premature infant with 3rd degree burns, and a term neonate with an extravasation necrosis caused by calcium gluconate. Surgical excision of necrotic tissue is a serious intervention and prolongs the duration of hospitalization. Enzymatic eschar removal may have an advantage over surgery especially in newborns with a high risk for surgery, with its possible complications, need for anesthesia, and perhaps for blood transfusion.