Togetherness of Ebstein anomaly and giant hairy nevus in a neonate: first case in the literature.

Özlü F, Tülüce M, Satar M, Özbarlas N, Kozanoglu B, Yücel A. Togetherness of Ebstein anomaly and giant hairy nevus in a neonate: first case in the literature. Turk J Pediatr 2018; 60: 744-746. Ebstein anomaly is a congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced through the apex of the right ventricle. Giant congenital melanocytic nevi originate from melanocytes. It is usually seen after birth. Here we present the first neonate with prenatally diagnosed with Ebstein anomaly with giant hairy nevus in the literature.

The Value of Etiological Tests and Skin Biopsy in the Management of Prurigo Simplex Subacuta.

It has been emphasized that prurigo simplex subacuta may be associated with various disorders and may be clinically confused with dermatitis herpetiformis. Aim of the study was to evaluate the value of our set of tests for finding possible associations and for the aforementioned differential diagnosis. Rates of implementations and abnormal results in our set of tests, including skin prick test, skin biopsy, complete blood count, blood chemistry panel, and psychiatric evaluation were analyzed retrospectively between the years of 2010 and 2015 in 130 patients clinically diagnosed with prurigo simplex subacuta. The set of tests was implemented completely in 43.8% patients and with only a single missing test in 31.5% of the patients. The least implemented procedure was psychiatric evaluation (66.9%). The most commonly found issues were psychiatric abnormalities (55.2% of 87 psychiatrically evaluated patients) and atopy (53.8% of 104 skin prick tested patients). The most common finding suggestive of internal diseases was hyperglycemia (25.4% of 130 patients). It was a striking result that hematological malignancies were suspected upon complete blood count and peripheral blood smear and confirmed by further investigations in 4 of 102 patients. Dermatitis herpetiformis was diagnosed in 2 of 120 skin biopsied patients. Because of the substantial rate of implementation, the high frequencies of psychiatric abnormalities and atopy, and detection of hematological malignancies and dermatitis herpetiformis even in just a few patients, we recommend our set of tests for patients clinically diagnosed as prurigo simplex subacuta.

Effects of Acute Carbon Monoxide Poisoning on ECG and Echocardiographic Parameters in Children.

The aim of the current study is to investigate the effects of CO (carbon monoxide) on the cardiovascular system via electrocardiographic, echocardiographic and biochemical findings in children. This prospective study included 22 children with CO poisoning and 24 healthy children as a control group. The CO-intoxicated children were evaluated via electrocardiography and echocardiography 1 h after admission to the emergency department and daily until their discharge from the hospital. Blood gasses, complete blood account, troponin I and creatinine kinase-MB(CK-MB) were assessed daily. Tpeak-end (p:0.001), QTc durations (p:0.02), Tpeak-end dispersion (p:0.001) and Tpeak-end/QT ratio (p:0.001) of CO-intoxicated patients were significantly higher than those in the control group. Mitral E duration (p:0.001), mitral E/A ratio (p:0.001) and left ventricle contractile fraction (p:0.023) at admission were significantly lower, and left ventricle myocardial performance index was higher (p:0.001) in the CO poisoning group. Troponin I and CK-MB levels were higher at admission in 6 (27 %) and 4 (18 %) patients, respectively. The heart is the most critical organ in pediatric CO poisoning. These children present subclinical systolic and diastolic left ventricle dysfunction even in mild cases. Although, in children with acute CO-intoxication ventricular repolarization is impaired, it seems to be reversible like other findings.

Cutaneous leishmaniasis: new dermoscopic findings.

BACKGROUND: Cutaneous leishmaniasis (CL) has a worldwide distribution. Delayed and incorrect diagnosis may cause the significant spread of this disease and consequent increases in morbidity and drug resistance. OBJECTIVES: We aimed to determine dermoscopic features of CL that may help to improve the accuracy of clinical diagnosis of the disease. METHODS: A total of 145 lesions in 102 patients were evaluated dermoscopically. Following the diagnosis of CL, all lesions were evaluated by experienced dermoscopists. RESULTS: A total of 51 papules, 40 nodulo-ulcerative lesions, 31 plaques, and 23 nodules were evaluated by dermoscopy. Generalized erythema appeared in all lesions (100%), yellow tears in 58 lesions, both crust and ulcer in 51 lesions, white starburst-like patterns in 27 lesions, ovoid salmon-colored structures in 19 lesions, and a perilesional hypopigmented halo pattern in four lesions. Various vascular structures were present in 126 lesions. The most common vascular structure observed was an irregular linear pattern in 78 lesions, followed by a tree-like pattern in 53 lesions. The rest of the vascular structures included hairpin vessels in 25 lesions, glomerulus-like vessels in 24 lesions, dotted vessels in 23 lesions, comma-shaped vessels in six lesions, and polymorphous/atypical vessels in four lesions. We did not identify the types of parasite involved. CONCLUSIONS: Yellow tears, white starburst-like patterns and salmon-colored ovoid structures seem to appear specifically in CL lesions. In geographical areas in which CL is common, dermoscopy may be utilized as a useful diagnostic tool that is practical and non-invasive.

The influence of training on the recognition of gross features of dermoscopy images.

BACKGROUND: In a dermoscopic examination, besides structural components, inexperienced clinicians should also be able to recognize the gross features of the images. AIM: The aim of this study is, whether or not an inexperienced clinician has problems in the recognition of gross features of the images on dermoscopic examination. METHODS: Two dermatologists, of whom one was experienced in the field of dermoscopy and the other was not, examined 161 dermoscopic images of melanocytic lesions in the gross features of their borders. Inner and outer borders were defined for each lesion. Both dermatologists separately evaluated the borders of the lesions for irregularity, asymmetry, and wideness of fading. For subjective image analysis they scored each lesion by using the four-point ordinal scale. For computerized image analysis they manually marked borders with dots, by using a computer program. We used quadratic-weighted kappa for interobserver reliability assessments for subjective scores and intraclass correlation coefficients (ICC) for automatically calculated scores. RESULTS: In a subjective evaluation the inexperienced observer used a higher score than the experienced observer and the kappa values were between 0.241-0.286. ICC for the automatically calculated scores were between 0.357 and 0.522. According to both the outer and the inner borders, the concordance between experienced and inexperienced observers was almost perfect in measurements of diameter, perimeter, and area (ICC scores were between 0.948 and 0.990). CONCLUSIONS: An inexperienced person, in comparison with an experienced person, sees lesions in the same sizes, but in different shapes on dermoscopy. Therefore, it is advisable that making learners familiar with the borders of lesions should be included in the training on dermoscopy.

Clinical evaluation of Behçet's disease: a five year follow-up study.

The frequencies of clinical features of Behçet's disease vary in different studies according to the diagnostic criteria used in the study, the department where the study is done, and the ethnic origin of patients included in the study. In this study, we aimed to evaluate the influence of the length of the follow-up period of patients on the frequencies of clinical features of Behçet's disease. Out of 231 patients who applied to our dermatology clinic from June of 1991 to October of 1996, only 52 patients that were followed up for at least five years were included in this retrospective study. The baseline characteristics of these 52 patients were almost the same as those of the 179 patients who dropped out. Almost all of the frequencies of clinical features at the end of the follow-up period of five years were higher than those at the time of presentation. The most prominent increases were observed for erythema nodosum (59.6% to 75.0%), papulopustular lesions (84.6% to 94.2%), and large vessel involvement (23.1% to 30.8%). According to our results, it is most likely that studies mainly including mostly patients with long-standing disease will report higher figures for the frequencies of these clinical features of Behçet's disease.