Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Comparison of topical 3% diclofenac sodium gel and 5% imiquimod cream for the treatment of actinic keratoses.

BACKGROUND: There is a wide spectrum of treatments available for actinic keratosis (AK). Topical diclofenac sodium and imiquimod are two topical treatments, which are noninvasive, easily applied, well-tolerated and effective. AIM: To compare the effects of topical 3% diclofenac sodium plus hyaluranon (DFS) gel, 5% imiquimod (IMQ) cream, and base cream (BC) in patients with AK. METHODS: In total, 61 patients, diagnosed clinically and histopathologically as having AK, were randomized into three treatment groups to receive topical treatment with either DFS (twice daily for 12 weeks), IMQ (twice per week for 16 weeks) or BC (twice daily for 12 weeks). Patients were evaluated clinically at 0, 4, 8, 12, 16, 20 and 24 weeks. Treatment efficacy was assessed by Total Thickness Score (TTS) and Patient Global Improvement Index (PGII). RESULTS: Complete clearance rates for DFS, IMQ and BC at the end of the treatment and at the end of the total follow-up period were 19.1%, 20% and 0%, and 14.3%, 45% and 0%, respectively. Although the average TTS value of the DFS group at week 24 was significantly higher than that of the IMQ group, the PGII values were not significantly different. CONCLUSIONS: Although DFS and IMQ each had considerable efficacy in the treatment of AK, the efficacy of DFS seemed to decrease after cessation of treatment.

Interobserver reliability of the Nail Psoriasis Severity Index.

BACKGROUND: Because the Psoriasis Area and Severity Index (PASI) does not consider the severity of nail disease, a scale that assesses the extent of involvement of psoriatic nails is needed. A new grading system, the Nail Psoriasis Severity Index (NAPSI) has been proposed. AIMS: The purpose of this study was to assess the interobserver reliability of NAPSI. Methods. The nail features of 25 patients with psoriasis with nail involvement were evaluated and graded by three dermatologists for total NAPSI scores and nail scores. The quadrants of all nails were examined for the presence of matrix and bed features. Total NAPSI score (0-160) of patients and nail score (0-32) of the individual nails were calculated. Interobserver reliability assessments were performed by computing intraclass correlation coefficients (ICC; two-way mixed model, consistency definition). RESULTS: The ICC((3,1)) results for total NAPSI score and nail score were found to be 0.781 and 0.649, respectively. The ICC((3,1)) for nail-bed and nail-matrix features were 0.869 and 0.584, respectively, in the total NAPSI scoring system, and 0.705 and 0.603, respectively, in the nail scoring system. CONCLUSION: Moderate to good agreement of scoring with the NAPSI was determined among the observers in this study. Our results suggest that scoring for nail-bed features seems to be more reliable than scoring for nail-matrix features.

Fluorescent in situ hybridization (FISH) for the detection of bacterial community in activated sludge from textile factories.

Conventional methods used to study the bacterial community structure in activated sludge are not sufficient enough to determine the compositions of the bacterial populations responsible for biodegradation. Activated sludge samples from 3 textile factories were analyzed by fluorescent in situ hybridization (FISH) using rRNA probes and by phase-contrast microscopy. In Factory-I, the predominant groups were the beta-subclass of Proteobacteria and the cytophaga-flavobacterium (CF) cluster (33.3% and 31.0%) followed by gamma-subclass (17.1%), high G+C DNA (HGC) gram-positive (15.4%) and alpha-subclass (3.2%). Factory-II showed a similar pattern (32.7%, 31.8%, 17.5%, 16.4%, 1.6%) but with lower concentrations, while Factory-III showed predominant alpha- and beta-subclasses (25.2%, 25.0%) and CF cluster (24.8%) followed by the gamma-subclass (13.6%) and the HGC (11.4%) at much lower concentrations. The floc characteristic for factory-I and -II was normal, however factory-III had diffuse and atypical flocs. In conclusion, the FISH technique provided comprehensive information on the bacterial consortia of activated sludge samples. The compositions of the bacterial community and their concentrations together with the floc characteristics might be some of the reasons that affect the operational efficiencies among the 3 textile factories.

Contact lens-related corneal ulcers in compliant patients.

PURPOSE: To report a case series of contact lens-related corneal ulcers in compliant patients with no apparent predisposing factors. DESIGN: Retrospective case series. METHODS: Charts of 70 patients with contact lens-related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study. RESULTS: Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses. CONCLUSION: Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses.

Mal de Meleda: a new geographical localization in Anatolia.

BACKGROUND: Mal de Meleda (MDM) is an autosomal recessive form of palmoplantar keratoderma first described on the Dalmatian island of Meleda. MDM has been observed in many other countries so that the origin of the MDM gene may be elsewhere than in Meleda. OBJECTIVE: After identification of the first MDM patient during a medical visit, a study was planned to reveal other families with MDM in the Köprüçay region in Anatolia. METHODS: The patient was interviewed with a questionnaire including a pedigree drawing. All the subsequent cases reported to be of MDM were visited for clinical examination and pedigree drawings. RESULTS: Thirty-nine patients, 8 families and 2 additional cases with MDM were identified in a 50-km(2) mountainous region in Köprüçay canyon in Anatolia. The prevalent clinical features were nail involvement (80%), 'glove-and-sock' distribution of the keratoderma (60%), edema on the hands/feet (60%), conical tapering of the fingertips (60%) and hyperhidrosis on the palms and soles (50%). CONCLUSION: To our knowledge, this is the largest series reported. The relationship between the patients in Meleda and those in Anatolia awaits discovery by further researches that will be carried out with the collaboration of dermatology, genetics and medical history departments.

Intraarterial Thrombolysis with r-tPA for Treatment of Anterior Circulation Acute Ischemic Stroke. Technical and Clinical Results.

SUMMARY: To investigate factors effecting the safety and recanalization efficacy of local intraarterial (IA) recombinant tissue plasminogen activator (r-tPA) delivery in patients with acute ischemic stroke. Eleven patients with anterior circulation acute ischemic stroke were treated. The neurological status of the patients were graded with the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS). All patients underwent a computed tomography (CT) examination at admission. In addition four patients had diffusion-weighted and one patient had a perfusion magnetic resonance (MR) examinations. Patients were treated within six hours from stroke onset. Immediate, six hours, and 24 hours follow-up CT examinations were performed in order to evaluate the haemorrhagic complications and the extent of the ischemic area. The Rankin Scale (RS) was used as an outcome measure. Two of the 11 patients had carotid "T" occlusion (CTO), nine had middle cerebral artery (MCA) main trunk occlusion. Four patients had symptomatic haemorrhage with a large haematoma rupturing into the ventricles and subarachnoid space. Of these, three patients died within 24 hours. The remaining seven patients had asymptomatic haematomas that were smaller compared to symptomatic ones, and showed regression in size and density on follow-up CTs. At third month five patients had a good outcome and three patients had a poor outcome. In acute ischemic stroke, local IA thrombolysis is a feasible treatment when you select the right patient. Haemorrhage rate does not seem to exceed that occuring in the natural history of the disease and in other treatment modalities.

Tardive dystonia associated with olanzapine therapy.

A 21-year-old man with the diagnosis of paranoid schizophrenia was admitted to our clinic with cervical dystonia developing at the end of the first year of olanzapine therapy. The present case suggests that tardive dystonia in this patient is most likely associated with olanzapine administration as this is the main antipsychotic he received. Regarding the few case reports of olanzapine-associated tardive syndromes, patients taking olanzapine should be carefully screened for the appearance of tardive movements.

Anxiety, depression, and nature of acne vulgaris in adolescents.

BACKGROUND: The reported prevalence of acne in adolescence is variable; improved treatment may have modified its prevalence and severity; acne has been related to psychiatric morbidity for many years. METHODS: Two thousand six hundred and fifty-seven high school students were examined, and adolescents with acne were interviewed about the subject of acne vulgaris. The severity of acne was graded using the Global Acne Grading System (GAGS). The Hospital Anxiety and Depression (HAD) scale was evaluated for one of every two subjects with acne (n = 308) and for the same number of sex-matched control subjects (n = 308) to determine the prevalence of depression and anxiety. RESULTS: Six hundred and fifteen of the subjects (23. 1%) were determined to have acne. Acne prevalence in girls and boys was 16.1% and 29.2%, respectively (P < 0.001). Two hundred and twenty-five (15.8%) of 1424 boys and only 109 (8.8%) of 1233 girls had moderate or severe/very severe acne (P < 0.001), but the GAGS scores in the groups of boys and girls with acne were not significantly different. The acne and control groups showed no significant differences in the HAD anxiety and depression subscale scores. The HAD anxiety subscale scores of girls were significantly higher than those of boys in the acne group. The severity of acne was not correlated with the HAD anxiety or depression subscale scores. CONCLUSIONS: Acne results in higher anxiety in adolescent girls. Although acne and moderate/severe acne are more common in adolescent boys, the severity of acne was found to be similar in boys and girls with acne. Adolescent girls are more vulnerable than boys to the negative psychological effects of acne.

New alternative agents in essential tremor therapy: double-blind placebo-controlled study of alprazolam and acetazolamide.

Propranolol and primidone are widely used, effective agents in essential tremor although they are not tolerated by all patients. In the present study, the effectiveness of alprazolam, a triazole analog of benzodiazapine class, and acetazolamide, a carbonic anhydrase inhibitor, were investigated as symptomatic treatments for essential tremor. We studied 22 patients with essential tremor in a double-blind, cross-over, placebo-controlled design. The patients received in random order alprazolam, acetazolamide, primidone and placebo for four weeks, each separated by a two-week washout period. The study demonstrated that alprazolam was superior to placebo and equipotent to primidone, whereas there was no statistically significant difference between acetazolamide and placebo. The mean effective daily dose of alprazolam was 0.75 mg and there was not any troublesome side effect reported by the patients on alprazolam. Alprazolam can be used as an alternative agent in elderly essential tremor patients who can not tolerate primidone or propranolol.

A case of spontaneous arm levitation in progressive supranuclear palsy.

Progressive supranuclear palsy is one of the parkinsonial syndromes causing atypical parkinsonism. In recent reports, other than subcortical involvement, also cortical structures have been shown to be involved in progressive supranuclear palsy patients. One of the clinical presentations of this involvement is spontaneous arm levitation which is a component of alien limb syndrome. Here we report a clinically diagnosed progressive supranuclear palsy patient with spontaneous arm levitation. Clinically spontaneous levitation of one arm without denial of ownership suggests the presence of spontaneous arm levitation. Spontaneous arm levitation can occur in the setting of progressive supranuclear palsy and it possibly demonstrates the cortical involvement in this disorder.

Sympathetic skin response in psoriasis and vitiligo.

The sympathetic skin response (SSR) which is considered to be one of the indexes of peripheral autonomic nerve function, especially evaluates sudomotor function of unmyelinated sympathetic fibers. This noninvasive technique has been studied in various neurological disorders particularly in peripheral neuropathies and also in some dermatological disorders associated with nervous system involvement. However, literature lacks sufficient data regarding SSR in immunologically mediated skin disorders. We enrolled patients with vitiligo and psoriasis to determine the possible effects of these disorders on SSR. Examination of SSR was performed in 30 patients with psoriasis and 15 patients with vitiligo as well as in 23 healthy volunteers as controls. Right and left median nerves were stimulated successively and responses were recorded from the palms simultaneously. SSR could be obtained from every subject. The groups were not statistically different for the values of the latency, the amplitude, and the area under the negative component of SSR. Our results indicated that vitiligo and psoriasis did not have any significant effects on SSR.

Motor neuron degeneration due to aluminium deposition in the spinal cord: a light microscopical study.

For a long time, aluminium has been considered as an indifferent element from a toxicological point of view. In recent years, it became clear that aluminium is a potential toxic agent in humans and has been implicated in the pathogenesis of several clinical disorders, such as dementia, respiratory tract disorders and allergic reactions. Chronic exposure to aluminium fumes, inhalation of aluminium and aluminium-oxide powder increase the risk to develop serious central nervous system pathology, in particular Alzheimer's disease and amyotrophic lateral sclerosis (ALS). In the present study, 3 experimental and 1 control group of rats were used to study the effects of aluminium on the central nervous system. Aluminium was injected intracisternally as a single dose (50 micrograms for group I, 100 micrograms for group II and 300 micrograms for group III) to the experimental groups (n = 5 in each group). The same dose was given at 3 months after the first injection to all groups. The control group (n = 5) was intracisternally given a physiological salt solution. Electromyography (EMG) was applied to the rats of the experimental groups. Rats were decapitated at 3 months after the second injections. Spinal cord samples from lumbar and cervical regions were removed and histological examination was performed. Light microscopical investigations revealed severe degeneration in motor neurons of the rats treated with 300 micrograms. Neurofibrillary tangle formation, chromatolysis and abnormal localization of the nuclei were found in swollen perikarya. Extreme loss of motor neurons with "ghost cell" appearance was found in that group. Sections of spinal cords of rats treated with lower doses of aluminium showed a moderate degree of motor neuron damage. EMGs of rats treated with the high dose of aluminium revealed severe acute denervation whereas treatment with lower doses resulted in moderate denervation. We conclude that aluminium may cause severe motor neuron damage in rat spinal cord resembling ALS.

High-frequency hearing and reflex latency in patients with pigment disorder.

PURPOSE: To investigate the activities of inner ear melanin in patients with pigment variations and disorders. Our purpose was to find evidence on the effects of melanin-containing cells by measuring the high-frequency threshold and the latency of stapes reflex in patients with vitiligo. PATIENTS AND METHODS: Twenty-nine patients with active vitiligo and 41 healthy subjects were included in this study. Pure tone thresholds were determined at frequencies between 250 and 16,000 Hz. Ipsilateral and contralateral stapes reflexes were measured at 1,000, 2,000, and 4,000 Hz. After we compared the results in the control and vitiligo groups by using the Mann-Whitney U test for each frequency, we compared women and men separately to eliminate gender differences. RESULTS: Pure tone thresholds of the vitiligo group were significantly lower than the control group at 4,000, 6,000, 8,000 and 10,000 Hz (P < .05). The statistically different thresholds were 8,000 and 10,000 Hz in women, compared with 4,000, 6,000, 8,000, 10,000, 12,500, and 16,000 Hz in men (P < 0.05). Reflex latencies for the two groups were not statistically different. CONCLUSION: Vitiligo, which is a type of pigment disorder, seems to be an effective factor in hearing loss, and men are more susceptible to it than women. The mechanism for this condition might be the absence of the preventive function of melanin-containing cells in the inner ear.

Auditory evoked potentials in vitiligo patients.

There is convincing evidence that vitiligo is a systemic disorder influencing the whole pigmentary system, including melanocytes in the inner ear. Cochlear melanocytes and also melanin-containing cellular elements of the auditory system may be affected in vitiligo and interfere with the conduction of action potentials. We conducted a prospective clinical trial to determine hearing status and auditory evoked potentials in 50 patients affected by vitiligo and compared the results with those of 50 healthy controls. I, III, V latencies and amplitudes and I-III, III-V, I-V interpeak latencies were compared with each group. Statistical evaluation was accomplished using the t-test. With the exception of two subjects, all patients demonstrated normal audiological results. No statistically significant difference was noted between the study group and controls in regard to latencies, interpeak latencies and amplitudes. We conclude that auditory investigations supported by postmortem histopathological studies of the inner ear and brainstem may provide more accurate knowledge in vitiligo patients.