Cytomorphometric Characteristics of Buccal Mucosal Cells in Behçet's Disease Patients.

BACKGROUND: The aim of this study was to compare the cytomorphometric characteristics of the buccal cells of Behçet's disease patients with those of healthy controls. METHODS: This case-control study compared a group of 30 patients with Behçet's disease with an age- and gender-matched control group of 30 healthy individuals. The buccal mucosal smears were stained using the Papanicolaou technique for cytomorphometric analyses. The nuclear and cytoplasmic areas were evaluated using digital image analysis; the ratio of nuclear to cytoplasmic areas and nuclear roundness are presented. RESULTS: The nuclear and cytoplasmic areas of the BD patients' cells were significantly smaller than those of the healthy controls' cells, while the nucleus-to-cytoplasm ratio and neutrophil infiltration rate did not differ significantly between the groups. However, the nuclear area, cytoplasmic area, nucleus-to-cytoplasm ratio, and nuclear roundness factor were significantly higher in patients without aphthae. The neutrophil infiltration rate did not differ significantly in patients with or without aphthae. CONCLUSION: Behçet's disease can produce cytomorphometric changes in buccal cells that are detectable by exfoliative cytology and cytomorphometric analysis techniques.

Serum levels of TWEAK in patients with psoriasis vulgaris.

Tumour necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK) has been implicated in the pathogenesis of a variety of inflammatory disorders and autoimmune diseases. However, studies conducted on the relationship of TWEAK and psoriasis patients are limited. In this study, we aimed to explore the serum levels of TWEAK and investigated whether TWEAK levels are associated with clinical variables and expression of other well-known psoriasis-related cytokines including IL-6, IL-23 and TNF-α. Forty-five patients with chronic plaque psoriasis and 43 controls were enrolled in this study. The severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Serum levels of cytokines were measured using commercial enzyme-linked immunosorbent assay (ELISA) kits. The mean TWEAK, IL-6, IL-23, and TN-α levels were significantly higher in psoriasis patients than in control subjects. However, there were no significant correlations between the psoriasis severity, the illness duration and serum cytokine levels. This study shows that TWEAK may be associated with the pathogenesis of psoriasis, like TNF-α, IL-6, and IL-23.

Investigation of the Association of the Second-to-Fourth Digit Ratio with Skin Sebum Levels in Females with Acne Vulgaris.

BACKGROUND: A relationship between acne vulgaris (AV) and the masculinized (lower) second-to-fourth digit (2D:4D) ratio in females was demonstrated in our previous study. Development of the digits and the sebaceous glands both occur during the same gestational period; therefore, the association between the 2D:4D ratios and AV may result from the effects of the prenatal endocrine environment on the sebaceous glands. OBJECTIVE: The aim of this study was to evaluate the relationship between the 2D:4D ratio and sebum levels in the skin of females with AV. METHODS: In total, 215 female AV patients and 92 healthy controls, aged 18-35 years, were enrolled in this study. Finger-length measurements were made using a digital Vernier caliper, and the sebum levels of five facial areas were measured using a Sebumeter SM 815. Acne severity was assessed using the International Consensus Conference on Acne Classification System. RESULTS: The 2D:4D ratios of the AV patients were significantly lower than those of the controls, for both hands. The mean sebum levels in the T-zone, U-zone and whole face were significantly higher for AV patients compared with controls. The 2D:4D ratio in the left hand showed significant negative correlations with the sebum levels in the U-zone; however, no association was found between the 2D:4D ratios and sebum levels in the T-zone and whole face. While acne severity was positively correlated with skin sebum levels, no correlation between acne severity and 2D:4D ratios was observed. CONCLUSION: This study provides preliminary evidence regarding the association between lower 2D:4D ratios and higher rates of sebum secretion in the U-zone for females with AV. The 2D:4D ratio might be a predictor of sebum levels, as well as acne development, in females.

The relation of PON1-L55M gene polymorphism and clinical manifestation of Behcet's disease.

PURPOSE: Behçet's disease is a multisystem disease characterized by recurrent oral and genital ulcers, relapsing uveitis, mucocutaneous, articular, gastrointestinal, neurologic, and vascular manifestations. Paraoxonase is believed to play an important role in protection of LDL and HDL particles from oxidation, in antioxidant effect against lipid peroxidation on cellular membranes, and in anti-inflammatory process. Lipid peroxidation and free oxygen radicals have been thought to play a role in pathogenesis of BD. The association of paraoxonase gene polymorphisms with Behçet's Disease in a group of Turkish patients with clinical manifestations and healthy controls has been investigated. PATIENTS AND METHODS: Paraoxonase (PON-1-L55M) gene polymorphism was investigated in 50 Behcet patients and 50 healthy individuals with a PCR/RFLP method. RESULTS: There were significant differences between patients and the control group in allele frequencies of the PON1 L55M polymorphism (p=0.04). Also, when patients were compared with the control group according to clinical manifestations, this statistical significance was getting sharper. Compared with the PON55 L allele, the M allele was associated with greater than 3.5 fold (OR 3.5, 95% CI 1.3-8.9) increased risk of ocular (OR 2.4, 95% CI 1.1-5.3), 2.4 fold joint and 3.1 fold (OR 3.1, 95% CI 1.1-8.4) central nervous system manifestations of BD. CONCLUSION: The PON L55M gene polymorphism seemed to play a role in the pathogenesis of BD.

Pulmonary and central nervous system involvement in Sweet's syndrome: a very rare case report.

Sweet's syndrome is a multisystem inflammatory disorder characterized by painful, erythematous plaques and aseptic neutrophilic infiltration of various organs. The absence of vasculitis is a histological criterion for diagnosis, but recent reports suggest that vasculitis can occur in Sweet's syndrome. Involvement of the central nervous system and the pulmonary system is very rare. In this case study we describe a chronic alcoholic man with Sweet's syndrome associated with acute-onset encephalitis and severe pulmonary involvement. The patient's symptoms responded dramatically to steroid treatment, and notably, a skin biopsy of his lesions showed vasculitis.

The increase in P-wave dispersion is associated with the duration of disease in patients with Behçet's disease.

AIM: P-wave dispersion (PD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. Behçet's disease (BD) is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Left ventricular diastolic dysfunction, ventricular arrhythmia and sudden cardiac death have been documented in Behçet's disease. The aim of this study was to evaluate myocardial involvement noninvasively in patients with BD by measuring PD. METHODS: Study population included 29 patients with BD (group I), (16 males, mean age: 60.4+/-10.1 years), and 45 normal (group II), (23 males, mean age: 61.2+/-12.0 years). The maximum and minimum P-wave duration (Pmax and Pmin) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed. RESULTS: There was no statistically significant difference between two groups in respect to age, gender, hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking (p>0.05). Pmax and PD of patients with BD were found to be significantly higher than those of control subjects (116.2+/-14.0 ms vs. 102.0+/-16.5 and 49.3+/-12.7 ms vs. 29.3+/-8.5 ms, respectively p<0.0001). Moreover, we found a significant positive correlation between PD with BD duration (r=0.78, p<0.0001). CONCLUSION: Pmax and PD are found to be greater in patients with BD than in controls and are related with the duration of the disease.

Lipid peroxidation and homocysteine levels in Behçet's disease.

BACKGROUND: The aim of this study was to investigate serum paraoxonase (PON1) activity in relation to homocysteine, malondialdehyde (MDA) and lipid parameters in active and inactive Behçet's disease (BD). METHODS: A total of 46 consecutive BD patients and 25 healthy control subjects were included in the present study. RESULTS: Serum PON1 activity in both active and inactive BD was significantly lower compared with healthy subjects (p<0.05). When compared to the control group, serum MDA levels were significantly higher in both active and inactive BD (p<0.05). Serum C-reactive protein (CRP) and homocysteine concentrations were significantly higher in active BD than those in inactive BD and control subjects (p<0.05). In addition, there was significant negative correlation between serum PON1 and MDA levels (r=-0.697, p<0.05) and serum PON1 activity was also negatively correlated with homocysteine levels (r=-0.428, p<0.05) in BD patients. CONCLUSIONS: Decreased PON1 could explain the increased lipid peroxidation and oxidative stress observed in BD. Also, according to our results, we suggest that homocysteine may contribute to decreased serum PON1 activity.

Evaluation of lipid peroxidation, oxidant/antioxidant status, and serum nitric oxide levels in alopecia areata.

BACKGROUND: The pathophysiology of alopecia areata (AA) has not been clearly defined; however, it appears as a tissue-restricted autoimmune disease mediated by T lymphocytes. Immunohistochemical studies have shown peri- and infra-follicular inflammatory infiltrate which damages hair follicles. We analyzed the role of lipid peroxidation and oxidant-antioxidant enzymes in the pathogenesis of AA. MATERIAL/METHODS: Twenty-four patients with AA and 20 age- and sex-matched healthy controls were enrolled in this study. We analyzed serum levels of malondialdehyde (MDA) and nitric oxide (NO) and the serum activities of superoxide dismutase (SOD) and xanthine oxidase (XO) in patients with AA and control subjects. RESULTS: The levels of MDA and NO (nitrite/nitrate) and the activity of XO in serum of patients with AA (0.76+/-0.34 nmol/ml, 14.88+/-6.40 nmol/ml, and 0.34+/-0.10 U/ml, respectively) were significantly higher than those of controls (0.35+/-0.09 nmol/ml, 10.71+/-1.75 nmol/ml, 0.11+/-0.03 U/ml; p<0.001, p<0.001, p<0.05, respectively). The SOD activity (12.95+/-2.16 U/ml) in the serum of patients with AA was significantly lower than that of controls (14.89+/-2.29 U/ml, p<0.05). CONCLUSIONS: Increased lipid peroxidation in AA may be related to an increase in NO level and XO activity and a decrease in SOD activity. These results suggest that lipid peroxidation and alterations in the oxidant-antioxidant enzymatic system may play a role in the pathogenesis of AA.

Sonographic appearance of congenital arteriovenous fistula of the hand.

Congenital arteriovenous fistula of the hand is uncommon. We report a case of unusual congenital arteriovenous fistula forming multiple fistulous communications between the arteries and veins in the right hand. Clinical findings were confirmed by color Doppler sonography and digital subtraction angiography.

Benign fibrous histiocytoma of the eyelid with an unusual clinical presentation.

Benign fibrous histiocytoma is a common soft tissue tumor that can be deep or superficially located. Although the deep type of fibrous histiocytoma has a predilection for the orbit, the eyelids are an unusual location for the cutaneous type. A 42-year-old woman had bilateral yellowish nodular masses of the eyelids for two years. Pathological examination after excision revealed benign fibrous histiocytoma. Our case is an unusual clinical presentation of cutaneous fibrous histiocytoma as well as a rare location such as the eyelids.

Effect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty.

A double-blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty. Sixty rhinoplasty patients undergoing hump resection and lateral osteotomy were included in the study and were divided into 6 groups: group 1 (n = 10), single dose of 8 mg intravenous (IV) dexamethasone 1 hour before the operation; group 2 (n = 10), single dose of 8 mg IV dexamethasone at the beginning of the operation; group 3 (n = 10), 3 doses of 8 mg IV dexamethasone 1 hour before the operation, and 24 and 48 hours after the operation; group 4 (n = 10), 3 doses of 8 mg IV dexamethasone at the beginning of the operation, and 24 and 48 hour after the operation; group 5 (n = 10), 3 doses of 8 mg IV dexamethasone immediately after the operation, and 24 and 48 hours after the operation; group 6 (n = 10), control, no dexamethasone administration before or after the operation. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and days 2, 5, 7, and 10. For the postoperative evaluation of periorbital ecchymosis and edema, a scale of 0 to 4 points was used. There was no significant difference between groups in terms of bleeding (P > 0.05). In the groups using steroid before osteotomy, edema and ecchymosis were significantly lower during the first 2 days compared with the control group (P < 0.05). No significant difference was seen between groups 1 and 2. When patients were evaluated on day 5, edema and ecchymosis were significantly lower in groups 3 and 4 (P < 0.05) compared with other groups, but there was no difference between them. Group 5 had a significantly higher level of edema and ecchymosis compared with groups 1 through 4 at 24 hours and at days 2, 5, and 7 (P > 0.05). There was no significant difference between groups on day 10. In conclusion, if the first dose is given before osteotomy, triple-dose steroid application is the best bet for decreasing postoperative edema and ecchymosis. None of the patients had any complications related to the use of dexamethasone.

Dual preconditioning: effects of pharmacological plus ischemic preconditioning on skin flap survival.

To enhance skin flap viability, pharmacological and ischemic preconditioning methods were investigated intensively. This study was designed to determine whether combined local dexamethasone administration and pedicle clamping would result in an additive enhancement of skin flap survival in the rat model. Twenty-eight male Sprague-Dawley rats were included in dexamethasone injection, clamping, clamping plus dexamethasone injection, and control groups. A rectangular random skin flap (3 x 11 cm) was outlined as bipedicled on the back of the animals. The dexamethasone or saline injection points in the flap were standardized. In the dexamethasone injection group, after raising the flaps, a total of 2.5 mg/kg dexamethasone was injected into the flaps. In the ischemic preconditioning group, 1 hour after saline injection, the cranial pedicle was clamped for 20 minutes and then 40 minutes reperfusion was performed. The clamping-plus-dexamethasone injection group was the same as the clamping group except dexamethasone was injected instead of the saline. In the control group, saline was injected instead of dexamethasone. Regardless of the group, all flaps were cut at the cranial side at the end of the 2 hours and were sutured back. On day 7, the surviving area was significantly greater in all experimental groups compared with the control group (p<0.05). Furthermore, the clamping-plus-dexamethasone group demonstrated the highest flap viability.

Complications of minor cutaneous surgery in patients under anticoagulant treatment.

Anticoagulant use is common in the elderly population. The role of these medications in the postoperative period is not well defined. We designed a prospective study to evaluate the incidence of postoperative complications in patients taking aspirin and warfarin. A prospective study was performed on 102 patients undergoing minor cutaneous plastic surgery. The number of subjects using regular aspirin, warfarin, and that of the patients with no anticoagulant medication were 37, 21, and 44, respectively. Complications were defined as minor, moderate, or major based on predetermined criteria. Of patients taking warfarin, 57% had some complication, significantly more than complications in the control group. The number of major complications in the warfarin group was significantly higher than those of the control and aspirin groups (p = 0.02). Also, the total number of complications in the warfarin group was significantly higher than the control group, but there was no significant difference between aspirin and control groups (p > 0.05). Cutaneous surgery in patients who receive warfarin is associated with a risk of major complication, but this risk does not exist in the patients receiving chronic aspirin treatment.