A case of erythema multiforme developing after levetiracetam therapy.

Erythema multiforme is a skin disease, which occurs particularly in the acral region, and is characterized by target-like erythematous macules and papules. Infections play an important role in the etiology of erythema multiforme. Other causes include drugs, vaccination, and hematological malignancies. Half of all cases may not have an identifiable etiology. This article presents a male patient who developed erythema multiforme as a result of levetiracetam use for epilepsy.

Primary localised laryngeal amyloidosis.

Localised amyloidosis of the larynx is uncommon and poorly understood. The precise etiology and pathogenesis are not entirely clear. It usually presents with hoarseness, pain and/or difficulty in breathing. We present the case of a 42-year-old woman with primary localised laryngeal amyloidosis who presented with hoarseness and dyspnoea. Biopsy of the specimen revealed amyloid.There were no signs of any systemic disease in the patient and diagnosis was established histopathologically. She was treated surgically by microlaryngoscopy under general anaesthesia. At 6 months, the patient's voice and breathing had both improved substantially.

The effect of carbon dioxide pneumoperitoneum on the severity of peritonitis.

BACKGROUND: There are still some doubts regarding the reliability of laparoscopic interventions in the presence of generalized peritonitis. The aim of the present experimental study was to investigate the effects of carbon dioxide (CO2) pneumoperitoneum on inflammatory response and peritonitis severity score in experimental peritonitis. METHODS: 21 Wistar albino rats were used in the study. The rats were distributed into three groups: the control group (Group 1, n = 7), the bacterial peritonitis-induced group (Group 2, n = 7), and the peritonitis+CO2 pneumoperitoneum-induced group (Group 3, n = 7). In Groups 2 and 3, peritonitis was induced by intraperitoneally injected Escherichia coli. In Group 3, pneumoperitoneum was induced by giving CO2 insufflations. The rats were sacrificed 24 hours later. Five cc of blood was sampled, and peritoneum tissue was excised from the abdominal region of the rats. Peritonitis severity score, C-reactive protein level and white blood cell count were assessed in all groups. RESULTS: Peritonitis severity score, C-reactive protein level and white blood cell count were significantly higher in Groups 2 and 3 than Group 1 (both, p < 0.05), while significantly lower in Group 3 than Group 2 (p < 0.05). CONCLUSION: The results of this study show that CO2 pneumoperitoneum decreases peritonitis severity and systemic inflammatory response in experiments with E. coli-peritonitis and sepsis.

Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye.

PURPOSE: The purpose of this study was to evaluate the efficacy of topical cyclosporine A (CsA) treatment in patients with severe trachomatous dry eye. METHODS: Sixty-four severe trachomatous dry eye patients who had undergone Schirmer testing with topical anaesthetic measured 5 mm or less and a tear film break-up time (TFBUT) of 5 s or less were included in the study. Thirty-two patients were treated with CsA 0.05% ophthalmic emulsion twice daily and concomitant five times daily non-preserved artificial tear, and the other 32 patients who were designated as the control group received vehicle emulsion twice daily and non-preserved artificial tear five times daily. Pretreatment and post-treatment evaluations included subjective assessment of the patients (total symptoms scores and ocular surface disease index [OSDI] scores), Schirmer testing with topical anaesthesia, TFBUT, rose Bengal and fluorescein staining scores, conjunctival impression cytological scoring and goblet cell counting. RESULTS: Following 6 months of CsA treatment, the differences between the pretreatment and post-treatment test results including total symptoms scores and OSDI scores, the rose Bengal and fluorescein staining scores, TFBUT values, and the Schirmer testing measurements were found to be statistically significant. Impression cytology also showed improvement of squamous metaplasia in 26 patients (81.25%) and increase in goblet cell density in 23 patients (71.88%). CONCLUSIONS: Topical CsA was effective in the treatment of severe trachomatous dry eye, yielding improvements in both objective and subjective measurements with a safety profile.

Familial cutaneous collagenoma: new affected family with prepubertal onset.

Two siblings presented with clinical and histopathological findings of familial cutaneous collagenoma which is a rare connective tissue nevus, inherited in an autosomal-dominant pattern. A 13-year-old girl had oval-round, soft, painless papules, 5-10 mm in size and a total of 9-10 on her abdomen and flanks. Skin biopsy demonstrated dense, coarse collagen fibers in the dermis and a decrease in elastic fibers. Doppler echocardiography indicated an atrioseptal defect of the secundum type. Her 9-year-old brother was also examined; four lesions were discovered on his back but he was otherwise normal. Our cases comprise the sixth affected family to be reported in the medical published work and all lesions had appeared prepubertally.

Letrozole-induced polycystic ovaries in the rat: a new model for cystic ovarian disease.

BACKGROUND: Our objective was to develop a new animal model for the study of polycystic ovaries by using the non-steroidal aromatase inhibitor, letrozole. METHODS: Thirty four rats were divided into four groups, including a control group of 10 rats that received vehicle only (1% aqueous solution of carboxmethlycellulose [CMC]) once daily orally (p.o.) and three treatment groups of eight rats each that were administered letrozole at concentrations of 0.1 or 0.5 or 1 mg/kg p.o. dissolved in 1% CMC (2 mL/kg) once daily. The treatment period was 21 days. During this period, vaginal smears were collected daily for estrus cycle determination. On the day subsequent to last letrozole dose administration, rats were killed; uteri and ovaries were then excised and weighed. Serum hormone levels and histologic changes in ovaries were examined. RESULTS: When compared to control group, ovaries from study groups showed high incidence of subcapsular ovarian cyst and capsular thickening together with incomplete luteinization and decreased number of corpora lutea. Letrozole treatment brought about dose-dependent suppression of uterine weight despite having no significant effect on ovarian weight. Although serum estradiol and progesterone levels were reduced in a dose-dependent manner, testosterone levels were elevated as were levels of luteinizing hormone (LH). Serum follicle-stimulating hormone (FSH) levels were markedly increased at higher doses of letrozole (0.5 and 1.0 mg/kg), contrary to low dose of letrozole (0.1 mg/kg) at which slight decrease was observed. CONCLUSIONS: Despite the fact that this is not a fully convincing model for the study of polycystic ovaries or of polycystic ovary syndrome (PCOS) as a whole, this animal model in several ways is similar to the human polycystic ovary syndrome.

Giant orf on the nose.

Ecthyma contagiosum, or orf, is a viral zoonosis of sheep and goats that can be transmitted to humans. In humans, it generally manifests as a solitary skin lesion, although rarely it can have an unusual course or be accompanied by systemic symptoms or complications. We present a case of giant orf lesion on the nose of a 9-year-old. The lesion grew rapidly and measured 5 cm by 4 cm and was attached to the right ala nasi by a base 2 cm round in diameter. The diagnosis was suggested by clinical and histopathologic appearance and confirmed by electron microscopic visualization of the virus. The lesion resolved spontaneously with minimal scarring and the entire cycle lasted about 3 months.

Intravitreal taurolidine against experimental Staphylococcus epidermidis endophthalmitis in rabbits.

PURPOSE: Taurolidine is a broad spectrum, non-antibiotic antimicrobial agent, not previously tested against infectious endophthalmitis. The efficacy of intravitreal taurolidine in the treatment of experimental Staphylococcus epidermidis endophthalmitis was evaluated and compared with vancomycin in a rabbit model. METHODS: The right eyes of 34 albino rabbits were infected with an intravitreal inoculum of S. epidermidis (10(5) colony-forming units/0.1 ml). The right eyes of four rabbits (group 7) were not infected and served as uninfected controls. 24 hours after inoculation of bacteria the animals were divided into the following treatment groups: group 1 (7 rabbits) received intravitreal taurolidine at 24 hours and group 2 (7 rabbits) received at 48 hours. Group 3 (7 rabbits) received vancomycin at 24 hours and group 4 (7 rabbits) at 48 hours. Group 5 (3 rabbits) received polyvinylpyrrolidone at 24 hours and group 6 (3 rabbits) at 48 hours. Clinical scoring was performed at 24, 48 and 72 hours. At 72 hours post inoculation, vitreous samples were collected for quantitative microbiological studies and then, the eyes were enucleated for histopathological scorings. RESULTS: The clinical and histopathological examinations revealed significant amelioration of inflammation in eyes treated with taurolidine and vancomycin when compared with polyvinylpyrrolidone. The eyes treated with taurolidine also had significantly lower colony forming units than the eyes treated with polyvinylpyrrolidone and taurolidine rendered many eyes sterile. CONCLUSION: Taurolidine is expected to be a potential agent for treatment of S. epidermidis endophthalmitis.

Aspiration and alcohol sclerotherapy: a novel method for management of Bartholin's cyst or abscess.

OBJECTIVE: To investigate the efficiency and safety of alcohol sclerotherapy of Bartholin's cyst or abscess by comparing it with silver nitrate insertion. STUDY DESIGN: Twenty-two patients with unilateral Bartholin's cyst or abscess were randomized into one of the treatment groups according to diameter of cyst or abscess. Group I consisted of 12 patients who were treated with alcohol sclerotherapy and Group II included 10 patients who were treated with silver nitrate insertion. In both groups, treatments were conducted under local anesthesia and in an outpatient setting. The patients were checked for morbidity of operations every 3 days until complete healing was observed and then followed up monthly for over 24 months. RESULTS: The mean duration of procedure was 7+/-2 min in group I and 15+/-3 min in group II. Healing time was 4.8+/-1.3 days in group I and 9.2+/-2.5 days in group II. In group I although 10 patients showed complete healing without any early or late morbidity; two patients suffered from severe vulval pain, edema and echymosis, and then developed a total cyst necrosis. Healing in these patients completed with mild scar formation. Only one recurrence was documented during 24 months follow-up period. All patients in group II complained labial pain, four of them suffered from severe labial pain, edema, and echymosis. Healing in these patients was completed with moderate scar formation. Follow-up of 24 months revealed no recurrence in this group. CONCLUSION: Alcohol sclerotherapy of Bartholin's cyst or abscess is as effective as silver nitrate application and is associated with less complication. It may be ideal, safe and attractive treatment modality for this gynecological disease.

Idiopathic retroperitoneal fibrosis mimicking a pelvic tumor: a case of pericystitis plastica.

Retroperitoneal fibrosis was first described in 1905 by Albarran, a French urologist, who performed ureterolysis for ureteral compression produced by the disease. However, this disease became an established clinical entity by Ormond's account in the English literature in 1948. Pericystitis plastica has been used the define an extremely rare type of Idiopathic retroperitoneal fibrosis (IRF) constricting the bladder. In this study, we discussed the recovery of 29-year-old woman with pericystitis plastica who was misdiagnosed as pelvic malignancy or a chronic/subacut pelvic inflammation at the first evaluation.

Effects of selenium on histopathological and enzymatic changes in experimental liver injury of rats.

The most important antioxidant aspect of selenium is its function in the active site of selenoenzyme glutathione peroxidase. Glutathione peroxidase not only allows the removal of the toxic radicals but also permits the regeneration of lipid molecules through reacylation in the cellular membrane. Thus, GSHPx may prevent the harmful effects of free radicals and may reduce the formation of the reactive metabolites of carbon tetrachloride. Carbon tetrachloride is a hepatotoxic agent which generates haloalkane radicals during its biotransformation in the liver and is widely used to make the experimental model of hepatic damage. Therefore, the aim of the present study is to investigate the possible protective role of selenium on the experimental liver cirrhosis and some enzyme activities in blood plasma from rats. While the activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were significantly increased (p < 0.05, p < 0.05 and p < 0.01, respectively), gamma-glutamyle transferase (GGT) activity was not statistically affected (p < 0.05) with carbon tetrachloride-injection. The levels of AST, ALT and GGT in carbon tetrachloride-group decreased to nearly the enzyme values in control-group after the selenium-injection but the ALP was increased (p<0.01). On the other hand, it was noticed that selenium significantly decreased the hepatic injury. In conclusion, our results showed that carbon tetrachloride caused an increase in the activities of liver enzymes in plasma and selenium application decreased the hepatic injury. Plasma levels of the liver enzymes were decreased after selenium-injections. Based upon these results, selenium may play an important role in the preventive indication of hepatic cellular injury inducted by carbon tetrachloride.

The effect of extracorporeal shockwaves on cartilage end-plates in rabbits: a preliminary MRI and histopathological study.

OBJECTIVE: The aim of this study was to examine the changes in the lumbar intervertebral area after extracorporeal shockwave therapy (ESWT) at different energy levels in a rabbit model using magnetic resonance imaging (MRI) and histopathological evaluation. METHODS: The study included 30 male New Zealand white rabbits divided randomly into five groups: Groups A and C received 1,000 shockwave impulses at an intensity of 14 kV, Groups B and D received 1,000 impulses at 21 kV, and Group E was a sham group. Side effects such as subcutaneous and paravertebral soft-tissue injuries were evaluated using MRI one day after ESWT administration. Neovascularization, edema and fibroblast activity in the intervertebral area were evaluated histopathologically. RESULTS: No change was observed in any group on MRI. Histopathologically, Groups A and C showed no change, whereas Groups B and D showed edema, fibroblast activity and significant neovascularization at the intervertebral end-plate (p<0.05). CONCLUSION: Our findings indicate that ESWT caused dose-dependent changes in the intervertebral end-plate. This study constitutes a preliminary evaluation of shockwave therapy to the intervertebral area in an animal model. High-dose ESWT may stimulate angiogenesis at cartilage end-plates in rabbits.

Increased liver mast cells in patients with chronic hepatitis C.

BACKGROUND AND AIM: The aim of the study was to investigate the mast cell (MC) concentration in the liver tissue of patients diagnosed with chronic hepatitis C and to determine whether there was a correlation with clinical and pathological characteristics of patients. MATERIALS AND METHODS: The study was conducted on liver biopsy samples from 60 patients with chronic hepatitis C. Clinical and laboratory data were obtained from follow-up records. Stained liver biopsies were examined. Immunohistochemical staining was performed by using an anti-c-kit antibody. Patients were divided into four groups (minimal, mild, moderate, and severe) based on the intensity of inflammation and their hepatic activity index scores and into two groups (no-mild, moderate-severe) according to fibrosis grade. RESULTS: Among patients enrolled, 60.0% (n=36) were men with a mean age of 48.3 ± 12.7 (range 18-64) years. The mean number of mast cells per portal area in the liver was 0.87 ± 0.86 (0-4.0). No correlation was found between alanine aminotransferase (ALT) and hepatitis C virus (HCV). Ribonucleic acid ( RNA ) levels and the degree of inflammation of cases with number of mast cells and liver steatosis (P>0.05). As the degree of fibrosis increased in the liver so did the number of mast cells in portal areas (P=0.001). On the other hand, no correlation was found between the degree of fibrosis and the number of MCs in the sinusoids and steatosis (P<0.05). The increase in the number of MCs in the portal areas correlated with an increase in liver steatosis (t: 0.02, P=0.04). CONCLUSION: In light of these findings, it appears possible that MC accumulation in chronic HCV patients may be used as an indicator of fibrosis and possibly be considered in the follow-up of these patients.

Primary renal synovial sarcoma.

Synovial sarcomas are generally deep-seated tumors that most often occur in the proximity of large joints of adolescents and young adults. We describe two cases of primary renal synovial sarcoma that were treated successfully by radical nephrectomy. Synovial sarcoma originating from the kidney is extremely rare and the histogenesis is uncertain. Surgical resection and ifosfamide based chemotherapy are the mainstay for the management of renal synovial sarcoma. Fewer than 40 patients have been described in the English literature. Physicians should be aware of the possibility of malignancy in cystic renal masses and raise the suspicion of synovial sarcoma, especially when patients with renal masses are a young adult.

Protective effects of selenium and vitamin E combination on experimental colitis in blood plasma and colon of rats.

Ulcerative colitis increases oxidative damage accompanied by production of free oxygen radicals. Selenium (Se) and vitamin E are two natural antioxidants. The present study was undertaken to investigate the possible protective role of Se and vitamin E combination in experimental colitis induced by acetic acid (AA) in rats. This study was carried out on three groups, namely the first (control), the second (experimental colitis group, 2 ml 5% acetic acid), and the third groups (2 ml 5% acetic acid, vitamin E (100 mg/kg body weight (bw)) plus Se (0.2 mg/kg bw)). The activities of catalase (CAT), prolidase (PRS), myeloperoxidase (MPO), total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), total thiol (T-SH) were determined in plasma and colon samples. Macroscopic and microscopic damages in colon were increased by AA treatment (p < 0.01 and p < 0.01, respectively), whereas they were decreased by selenium and vitamin E treatment (p < 0.05 and p < 0.01, respectively). The activities of CAT and PRS in the plasma and colon were significantly affected (p < 0.05 and p < 0.01) by treatment of AA, Se, and vitamin E. MPO activity in colon was increased (p < 0.01) by AA treatment and decreased (p < 0.05) by Se and vitamin E administration. The values of TOS and OSI in plasma were increased (p < 0.5) by AA. The TAC and T-SH in colon were decreased (p < 0.05) by AA and increased (p < 0.05) by Se and vitamin E. Based upon these results, Se and vitamin E may play an important role in preventive indication of the oxidative damage associated by acetic acid caused inflammation.

Oxidative and antioxidative status in the testes of rats with acute epididymitis.

INTRODUCTION: Epididymitis is an inflammation or infection of the epididymis, a convoluted duct that lies on the posterior surface of the testicle. Oxidative stress due to excessive production of reactive oxygen species in epididymitis, impaired antioxidant defense mechanisms, or both, precipitates a range of pathologies that are currently believed to negatively affect the male reproductive function. How oxidative stress affects the testes is still unknown. We aimed to investigate the oxidative and antioxidative status of testes of rats with unilateral acute Escherichia coli epididymitis. METHODS: The study included 36 male Wistar albino rats which were divided into three groups. In the epididymitis group (n = 12), an E. coli suspension was injected into the right ductus deferens of rats, and the same amount of saline was injected in the saline groups (n = 12). No surgery was performed in the control group (n = 12) for baseline values. Rats were sacrificed after 24 h and the epididymis and testes removed. The infection was confirmed by histopathologic evaluation and microbiological tests. The oxidative status of testes was evaluated by measuring myeloperoxidase (MPO) activity, and antioxidative status was evaluated by measuring total antioxidant response (TAR) and total antioxidant capacity levels (TAC). RESULTS: MPO activity in both the ipsilateral and contralateral testes of the epididymitis group was significantly higher than those of the saline and control groups (p < 0.05). The TAR and TAC levels in both testes were also significantly elevated in the epididymitis group versus the two other groups (p < 0.05). CONCLUSIONS: Acute epididymitis causes an increase of oxidative stress in the ipsilateral and contralateral testes, but this condition is strived for to tolerate the increase of endogenous antioxidants.

[Culture of Plasmodium berghei ANKA in BALB/c mice and research on experimental cerebral Malaria.]. / Plasmodium berghei ANKA susunun BALB/c farelerde kültürü ve deneysel serebral sitmanin arastirilmasi

Plasmodium berghei ANKA 6653 isolates that cause malaria in rodents were cultured in BALB/c mice in this study. Each of the BALB/c mice were injected intraperitoneally with 0.3 ml from a stock solution containing 160.000 parasites/ml. Percentage values of parasitemia at day 3, 6, 9 and 15 after injection were recorded and graphed. The neurological signs after day 3 were recorded in this study. At the end of day 15, cerebral tissues of dead mice were taken and the accumulation of hemorrhages was investigated. A total of 97 inbred BALB/c mice weighing approximately 17-20 gr. were used in this study.

High rate of seropositivity of Chlamydia pneumoniae IgA in male patients with nonalcoholic steatohepatitis.

The aim of this study was to investigate if there was any relationship between nonalcoholic steatohepatitis and the rate of Chlamydia pneumoniae seropositivity in a male population. Fifteen men with nonalcoholic steatohepatitis and 20 healthy men were enrolled in the study. The seropositivity rate of Chlamydia pneumoniae immunoglobulin A in the nonalcoholic steatohepatitis and control groups was 53.3 and 5%, respectively. The rate of Chlamydia pneumoniae immunoglobulin A positivity was significantly higher in the nonalcoholic steatohepatitis group than the controls (P = 0.002), while such a difference did not occur for Chlamydia pneumoniae immunoglobulin G positivity (P > 0.05). There is an association between nonalcoholic steatohepatitis and persistent Chlamydia pneumoniae infection as a probable causative or triggering agent. These findings suggest that further studies are necessary to clarify this association.

Nonfunctioning adrenocortical carcinoma in a child.

Pediatric nonfunctioning adrenocortical carcinoma is a very rare tumor. A 4-year-old girl was admitted complaining of abdominal pain. Physical examination revealed an abdominal mass. There were no clinical or laboratory signs of hormonal abnormality. Abdominal ultrasonography revealed a polylobular mass. Intravenous pyelography showed marked compression of the kidney by a tumor. The tumor was excised together with the right kidney. The histopathological diagnosis was adrenocortical carcinoma. Although there is a greater incidence of germ line p53 mutations with adrenocortical carcinoma, the tumor suppressor gene p53 was not mutated in our case. The girl died 2 months after surgery from complications of chemotherapy.

The experimental model of hydatidosis in rabbit testis. A preliminary study.

OBJECTIVES: Although no part of the human anatomy is invulnerable to hydatid disease, it has been reported to occur mostly in vital organs such as liver, lungs and brain. Hydatid disease of the urinary tract is uncommon accounting for only 2% of all such cases. Testes are extremely rare sites for echinococcosis. To our knowledge there are only 3 cases of testicular hydatid cyst described. In this animal model, we studied echinococcosis in rabbit testis. METHODS: We directly infected the unilateral testis of 4 male rabbits with infective protoscolices via intratesticular injection and housed them under pathogen-free conditions for 10 weeks. All rabbits survived during the follow-up period and then, at the 10th week, all testes were removed for histopathologic investigation. RESULTS: Despite of the direct infection of the rabbit testes with Echinococcus granulosus, there was no demonstrable hydatid cyst after a 10-week period except from some fibrosis in the injection tract of the testicular tissue in 1 case. CONCLUSION: The testes are extremely rare anatomic locations for echinococcosis infection. The mechanism of this resistance should be another reason apart from blood-testicular barrier. We think that low temperature in the scrotum or different properties of the testicular tissue may be the reasons of this defense mechanism. If this hypothesis clarifies with the further studies, new treatment options may be defined in the medical literature for the hydatid cyst.