Intravitreal triamcinolone acetonide injection in CRVO associated with Wegener's granulomatosis.

A 33-year-old man developed unilateral non-ischemic central retinal vein occlusion associated with systemic Wegener's granulomatosis. Four milligrams of triamcinolone acetonide was injected intravitreally twice 6 months apart in conjunction with ongoing systemic immunosuppressive therapy. No change was made in the systemic immunosuppressive regimen. Wegener's granulomatosis should be considered in the differential diagnosis of central retinal vein occlusion in the young age group and intravitreal triamcinolone acetonide is a good adjunct to systemic immunosuppressive therapy that eliminates the need for modifying the systemic treatment regimen.

Accelerated versus classical hepatitis B virus vaccination programs in healthcare workers accelerated vs. classical HBV vaccination.

BACKGROUND: The aim of this study was to compare the efficacy of a standard hepatitis B virus vaccination program (day 0-30-60) with an accelerated vaccination program (day 0-10-21) in healthy healthcare workers. MATERIAL/METHODS: Participants were randomly assigned to a classical (group 1, days 0, 30, and 60) or an accelerated vaccination program (group 2, days 0, 10, and 21). The vaccine used was 20 pg recombinant hepatitis B vaccine (recombinant hepatitis B vaccine derived from yeast cells, Engerix B, Smith Cline Beachum). HBV markers were re-examined for the emergence of anti-HBsAg and also to detect the development of a possible acute HBV infection one, two, and three months after the last dose of vaccine. Anti-HBsAg titers >10 mIU/l were accepted as protective. RESULTS: The seroprotection rates were similar one, two, and three months after the last dose of vaccine in both groups. Anti-HBsAg titers in group 1 were higher than in group 2 two and three months after the last dose of vaccination (p<0.05). CONCLUSIONS: Our data indicate that the accelerated HBV vaccination program was as effective as the classical vaccination program.

[An imported case of mixed malaria caused by Plasmodium falciparum and Plasmodium ovale.]. / Plasmodium falciparum ve Plasmodium ovale'nin etken oldugu importe bir miks sitma olgusu.

Malaria caused by Plasmodium species is an important parasitic infection in Turkey as in the rest of the world. Malaria cases originating in our country are caused by P. vivax; those caused by other Plasmodium spp. are imported cases. In this article, after work-related travel to Cameroon, a patient who acquired specific clinical signs and symptoms of malaria has been evaluated. The major clinical findings of the patient were fever, chills and shaking. After examination of thin and thick blood smears prepared from the peripheral blood of the patient, a 20% rate of Plasmodium parasitemia was obtained and the case was considered to be a mixed P. falciparum and P. ovale infection. In addition, P. falciparum infection was confirmed using the Optimal Malaria Rapid Test and the presence of another Plasmodium species besides P. falciparum was confirmed. Primaquine was added to quinine and doxycycline therapy for P. ovale hypnozoites. No Plasmodium was found in control blood smears after clinical improvement. In this case, it has been emphasized that in differential diagnosis of fever seen after travel to malaria endemic areas, malaria must be considered and prophylaxis must be carried out before travel.

A case of familial Mediterranean fever and polyarteritis nodosa complicated by spontaneous perirenal and subcapsular hepatic hemorrhage requiring multiple arterial embolizations.

The association of familial Mediterranean fever (FMF) and polyarteritis nodosa (PAN) has been well established. These patients have been reported to have an overall better prognosis than other PAN patients. Herein we report a patient with FMF and PAN who died of sepsis following a severe course of recurrent bleeding episodes which required multiple embolization attempts. The 39-year-old Turkish male presented with abdominal pain of 1-month duration. He had been diagnosed with FMF at the age of 24. On admission, he had pallor with general ill appearance. Rebound tenderness was obtained in the right upper abdominal quadrant. He had mild anemia, leukocytosis, thrombocytosis, and hypoalbuminemia. On the 2nd day of his admission, he developed hypotension with a rapid decline in hemoglobin level. Abdominal angiography showed multiple aneurysms in the branches of renal arteries, superior mesenteric artery, and hepatic arterial system including left renal infarct, suggesting PAN. He was put on high-dose steroids and oral cyclophosphamide. Despite medical treatment, he developed intense abdominal pain, hypotension, tachycardia, and a rapid fall in hemoglobin on four occasions. Active bleeding sites were embolized in two different angiography sessions. Although the patient experienced no more recurrent bleeding, he died of multiorgan dysfunction syndrome resulting from sepsis 6 weeks after admission. Polyarteritis nodosa associated with FMF may follow a grave course despite immunosuppressive therapy. Arterial embolization should be considered in the presence of bleeding aneurysms in addition to immunosuppressive therapy.