Pregnancy-like (pseudolactational) hyperplasia: uncommon cause of microcalcifications and mass in two cases.

Pregnancy-like (pseudolactational) hyperplasia (PLH) is an uncommon lactational change occurring independently from pregnancy and lactation. PLH has been incidentally found during breast biopsies. We report two different cases of PLH with their clinical, radiologic, and pathologic findings.

Two foreign body reactions caused by suture materials: mammograms mimic cancer as a spiculated lesion.

A spiculated breast lesion on mammogram is highly suggestive of malignancy. However, it can be seen on rare occasions in benign conditions including foreign body associated granuloma. We describe two foreign body reactions in the breast caused by suture materials and describe the clinical, radiological and pathological features.

Immunoregulatory effects of isotretinoin in patients with acne.

BACKGROUND: In vitro studies have shown that retinoids influence T-cell differentiation. OBJECTIVES: To study the effect of isotretinoin on T-cell differentiation markers in patients with acne. METHODS: A total of 37 patients with acne vulgaris (25 female, 12 male, age 19.6 ± 3.7 years) and 30 age- and sex-matched healthy controls (19 female, 11 male, age 20.5 ± 4.4 years) were included in the study. Screening for biochemical parameters in serum samples were done just before initiation (pretreatment) and after 3 months of isotretinoin treatment (post-treatment) in the acne group. RESULTS: Baseline levels of tumour necrosis factor (TNF)-α (P<0.0001), interleukin (IL)-4 (P<0.0001), IL-17 (P<0.0001) and interferon (IFN)-γ (P=0.002) were significantly higher in the acne group compared with the control group. TNF-α (P<0.0001), IL-4 (P<0.0001), IL-17 (P<0.0001) and IFN-γ (P<0.0001) levels decreased after isotretinoin treatment. TNF-α and IL-4 values after isotretinoin treatment were similar to those of the control group. However, levels of IL-17 (P<0.0001) after isotretinoin treatment were higher than those of the control group, despite a significant decline after treatment. Levels of IFN-γ (P<0.0001) after isotretinoin treatment were lower than those of the control group. CONCLUSIONS: This study shows that isotretinoin treatment significantly decreases TNF, IL-4, IL-17 and IFN-γ levels in patients with acne. We failed to show that isotretinoin redirects naive T helper (Th) differentiation preferentially towards the Th2 cell lineage.

Relationship between hair cadmium levels, indoor ETS exposure and wheezing frequency in children.

BACKGROUND: Cadmium (Cd) is a toxic heavy metal and the components of tobacco and scalp hair effectively reflect a long-term environmental exposure. OBJECTIVE: The aim of this study was to assess the concentration of Cd levels in the hair of children with recurrent wheezing, and to evaluate the predictors of elevated Cd levels with a focus on anthropometric, environmental, and dietary factors. METHODS: In this case-control study, scalp hair was obtained from 65 children with recurrent wheezing (RW) and from 65 healthy children (HC). Hair Cd concentrations were determined by ICP-MS. RESULTS: Median (IQR) hair Cd levels were 0.22 µg/kg (0.10-0.35) in RW group and 0.12 µg/kg (0.04-0.23) in HC group (p = 0.013). Multivariable logistic regression model results showed that being a child with RW (OR = 6.28; p = 0.001), ETS exposure at home (OR=22.56; p < 0.001), and mother's education level (OR = 0.49; p = 0.020), are the major predictor variables for elevated hair Cd levels (cut off >0.17 µg/kg). In RW group, multivariable logistic regression results showed that hair Cd levels of >0.17 µg/kg was significantly predictive of having three or more wheezing episodes in RW group after adjustment for ETS exposure at home (OR = 5.48; p = 0.012). CONCLUSION: We demonstrated that the more children are exposed to ETS at home, the more they are exposed to heavy metals like Cd. Especially children who have had three or more wheezing attacks over the last six months are much more susceptible than the other asthmatic and non-asthmatic children, and Cd exposure aggravates their asthmatic status.

Serum holotranscobalamine, vitamin B12, folic acid and homocysteine levels in patients with vitiligo.

Few studies have investigated the role of vitamin B12 metabolism in vitiligo. We tested the hypothesis that vitamin B12 and folate metabolism might have an influence on the pathogenesis of vitiligo. Full blood count and levels of folic acid, vitamin B12, homocysteine and holotranscobalamine were examined for 69 patients with vitiligo and 52 controls. The vitiligo group had higher levels of homocysteine (P < 0.01) and haemoglobin (P < 0.01) levels, and lower levels of vitamin B12 (P < 0.01) and holotranscobalamine (P < 0.0001) than the control group. Folic acid levels were similar for both groups. In a risk analysis, hyperhomocysteinaemia (≥ 15 µmol/L, P < 0.01) and vitamin B12 deficiency (< 200 pg/mL, P < 0.01) were significant risk factors for vitiligo. Patients with holotranscobalamine levels in the lowest quartile had an increased risk for co-occurrence of vitiligo (P < 0.005). Vitamin B12 deficiency and hyperhomocysteinaemia may share a common genetic background with vitiligo.

Primary appendicealtumors: clinical imaging and pathological findings. Report of four cases.

Primary appendiceal tumors are rare clinical and radiological entities. We report 4cases including muscinous cystadenoma associated with pseudomyxoma peritonei, muscinous cystadenoma associated with mucocele, low-grade muscinous neoplasia associated with appendicitis in elderly patients, and carcinoid tumor associated with appendicitis in a young adult.

Isotretinoin does not induce insulin resistance in patients with acne.

BACKGROUND: Isotretinoin treatment causes hypertriglyceridaemia. Insulin resistance is also associated with hypertriglyceridaemia. It is not known if isotretinoin is related to insulin resistance. AIM: To test this hypothesis, we measured insulin resistance in 48 patients with acne vulgaris (AV) before and after 3 months of isotretinoin treatment. METHODS: In total, 48 patients with AV who attended the dermatology outpatient clinic at Kecioren Research and Training Hospital were included. Screening for biochemical parameters was performed just before the start of treatment (pretreatment) and after 4 months of isotretinoin therapy (post-treatment). The parameters measured were insulin, C peptide, fasting blood glucose, aspartate and alanine aminotransferases (AST, ALT), total cholesterol (TC), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL-C) and very low-density lipoprotein cholesterol. Insulin resistance was measured using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) method. RESULTS: Compared with initial values, AST, ALT, TC, LDL-C and triglyceride levels were significantly increased (P < 0.01, < 0.05, < 0.01, < 0.05 and < 0.01, respectively), but there was no significant change in fasting blood glucose, insulin, C-peptide levels or HOMA-IR. CONCLUSIONS: Three months of isotretinoin treatment did not change insulin sensitivity in patients with AV. Further studies with insulin resistance models may even reveal an improvement in insulin resistance, as experimental animal studies have previously shown.

An obesity drug sibutramine reduces brain natriuretic peptide (BNP) levels in severely obese patients.

OBJECTIVES: Sibutramine is a selective inhibitor of the reuptake of monoamines. Plasma levels of brain natriuretic peptide (BNP) appear to be inversely associated with body mass index (BMI) in subjects with and without heart failure for reasons that remain unexplained. The aim of this study was to investigate the possible influence of sibutramine treatment on BNP levels in severely obese patients. METHODS: Fifty-two severely obese female patients with BMI > 40 kg/m(2) were included to this study. The women were recommended to follow a weight-reducing daily diet of 25 kcal/kg of ideal body weight. During the treatment period, all patients were to receive 15 mg of sibutramine once a day. Blood chemistry tests were performed before the onset of the medication and after 12 weeks of treatment. RESULTS: None of the subjects was withdrawn from the study because of the adverse effects of sibutramine. Body weight (108.8 +/- 13.3 kg vs. 101.7 +/- 15.6 kg, p < 0.001), BMI (44.6 +/- 4.6 kg/m(2) vs. 41.8 +/- 5.7 kg/m(2), p < 0.001) and BNP [8.6 (0.5-49.5) ng/l vs. 3.1 (0.2-28.6) ng/l, p = 0.018] levels were significantly decreased after 12 weeks of sibutramine treatment. Total cholesterol (5.19 +/- 0.90 mmol/l vs. 4.82 +/- 1.05 mmol/l respectively; p < 0.001), low-density lipoprotein-cholesterol (3.26 +/- 0.86 mmol/l vs. 2.99 +/- 0.40 mmol/l respectively; p = 0.008), levels were significantly decreased; however, there was no significant alteration in high-density lipoprotein-cholesterol and triglyceride levels. CONCLUSION: This study has shown a decrease in BNP levels which may lead to improvement in cardiac outcome after sibutramine treatment. Further randomised studies are needed to be conducted to clarify the relationship between sibutramine and BNP.

Short-term isotretinoin treatment decreases insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels: does isotretinoin affect growth hormone physiology?

BACKGROUND: Isotretinoin is an effective treatment for acne vulgaris. However, it has numerous side-effects. It was previously reported that serum growth hormone (GH) levels decreased with isotretinoin treatment. OBJECTIVES: To analyse whether isotretinoin has any effects on insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP3) and GH levels. METHODS: Forty-seven patients aged 21.5 +/- 5.1 years (mean +/- SD) with acne vulgaris were included in this study. Isotretinoin therapy was initiated at a dose of 0.5-0.75 mg kg(-1) daily and then adjusted to 0.88 mg kg(-1) daily as maintenance dosage after 1 month. Screening for biochemical and hormonal parameters was performed just before initiation and after 3 months of isotretinoin treatment. RESULTS: IGF-1 and IGFBP3 levels decreased significantly after treatment (P < 0.01), while GH levels did not change. Post-treatment, significant increases were seen in aspartate aminotransferase, total cholesterol, low-density lipoprotein cholesterol, triglycerides and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P < 0.0001) while high-density lipoprotein cholesterol levels were significantly decreased (P < 0.0001). CONCLUSIONS: Isotretinoin therapy may have an effect on GH physiology, and further studies are needed to understand this association.

The mechanism of the late preconditioning effect of 3-nitropropionic acid.

The aim of the present study was to investigate the mechanism of effect of 3-nitropropionic acid-(3-NP) induced late preconditioning in rat heart. For this purpose 20-30 min before 3-NP (20 mg/kg, i.p.) injection, the rats were treated intraperitoneally with 5-hydroxydecanoate (40 mg/kg, 5-HD, mitochondrial K(ATP)-channel blocker), L-NAME (100 mg/kg, NOS inhibitor), N-2-mercaptopropionylglycine (100 mg/kg, MPG, free radical scavenger), or superoxide dismutase+catalase (10000+10000 IU/kg, SOD+CAT). Control rats received saline only without 3-NP pretreatment. After two days, hearts were isolated and perfused at a constant pressure in a Langendorff apparatus. 15-min global ischemia followed by 30-min reperfusion was applied to all hearts. Pretreatment of 3-NP significantly reduced infarct size, creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) levels, and incidence of ventricular tachycardia (VT) compared with the control group receiving saline only. 5-HD, L-NAME, MPG, or SOD+CAT treatment statistically reversed 3-NP-induced reduction in infarct size. Although CK-MB, LDH levels, and incidence of VT were also reduced by L-NAME, MPG, or SOD+CAT treatment, only 5-HD significantly inhibited beneficial effects of 3-NP on all of the parameters above. These results showed that mito-K(ATP) channels play a pivotal role in late preconditioning effect of 3-NP in the isolated rat heart. However, other mediators such as reactive oxygen species and NO may be, at least in part, involved in mechanisms of this effect.

Localized fluid collections after liver transplantation.

BACKGROUND: Liver transplantation is an accepted effective therapy for patients with diseases that lead to hepatic failure. In addition to vascular, rejection-related, biliary, and lymphoproliferative complications, posttransplantation fluid collections, such as hematomas, seromas, bilomas, localized ascites, and abscesses can affect graft survival. In this study, we have presented, ultrasonography and computed tomography images as well as reviewed the literature. METHODS: Between December 1988 and March 2005, 138 patients (94 men [68.11%], 44 women [31.89%] of mean age, 26.77 years (range, 1 to 64) underwent liver transplantation in our institution from living-related donors in 85 and deceased donors in 53 recipients. This retrospective study analyzed the fluid collections diagnosed after liver transplantation. RESULTS: Among 138 liver transplants we identified 56 localized intra-abdominal fluid collections, including 46 hematomas, 4 bilomas, and 6 abscesses. Fluid collections were noticed between 0 and 1095 days (mean = 13.50 +/- 152.82 days). Thirty-three collections were identified in living-related, and 23 in deceased donor recipients. The collections showed an average volume of 375 cm3, with a range of 1 to 4368 cm3. Two cases of bilomas were related to hepatic arterial insufficiency, one from a hepatic artery occlusion and the other from a significant stenosis. CONCLUSIONS: Localized intra-abdominal fluid collections were commonly seen after liver transplantations, diminished in size without treatment, but required aspiration or drainage in some patients.

Bluetongue surveillance methods in the United States of America.

Historical surveillance for bluetongue virus (BTV) exposure in the United States of America (USA) has relied on periodical serological surveillance using samples collected from cattle at slaughter. Most of this surveillance has been focused on the north-eastern portion of the USA due to the lack of competent vectors of BTV in this region. For most of the states tested in this region, the prevalence of seropositive animals has been less than 2%. Recently, a study was conducted in north-central USA using sentinel cattle herds. Results of serological testing showed an increasing gradient of exposure from north to south. In addition, detection of Culicoides sonorensis showed a similar gradient with detection in the northern areas being relatively rare. The results of these studies indicate that cattle herds in the northern and north-eastern areas of the USA are likely to be free of BTV.

Haemophilus influenzae cellulitis of the extremities.

A brief case report is described of a 10-month-old male with Haemophilus influenzae cellulitis of the upper extremity. A review of the literature concerning this pathogen in extremity cellulitis follows, with discussion of epidemiology, site of infection, response to therapy, and possible pathogenesis.

Trolamine salicylate cream in osteoarthritis of the knee.

Twenty-five patients with symptomatic osteoarthritis (OA) of the knee were treated topically for one week with either 10% trolamine salicylate cream or placebo cream in a randomized double-blind crossover study. No significant difference was found in subjective or objective measures of pain relief between the treatment and control groups. Eight patients preferred "active" test cream, six preferred placebo, and 11 had no preference. No side effects were reported. Topically applied 10% trolamine salicylate cream did not relieve the pain of OA of the knee any more than did placebo.