Atypical Presentation of Pilomatricoma: A Case Report

BACKGROUND: Malherbe tumors, also known as pilomatricomas, are benign cutaneous tumors of hair matrix origin. OBJECTIVE: To discuss a rare case of multiple pilomatricoma of the head and neck region in a very young patient. METHODS: A 14-month-old baby presented with two lesions, one appearing on the preauricular region and the other on the nasolabial fold. One of the lesions showed significant ulceration. RESULTS: Excisional biopsy was performed for both of the lesions. Although the histopathologic examination suggested pilomatricoma as the diagnosis, the lesion with ulcerations exhibited increased mitosis which made us consider pilomatrix carcinoma in its differential diagnosis. CONCLUSION: Increased mitoses, an uncommon unexpected feature for pilomatricoma, can be a marker for more aggressive biologic behavior.     

Effect of carbon dioxide pneumoperitoneum on bacteremia and severity of peritonitis in an experimental model

Background: Laparoscopy is increasingly used in conditions complicated by peritonitis. A theoretical concern is that carbon dioxide pneumoperitoneum may increase bacteremia. Method: In 60 rats peritonitis was induced by cecostomy. Animals were randomly allocated to pneumoperitoneum (PP) and control groups. Blood cultures and intraabdominal swabs were assessed. A peritonitis severity score (PSS) was computed based on histology from peritoneal biopsy. Results: One hour after cecostomy neither in abdominal swabs nor in blood samples bacteria were reproduced in PP and control groups. Three hours after cecostomy the frequency of positive blood cultures was 80% and 20% in PP and control groups, respectively (p < 0.0001). Six hours after cecostomy the frequency of positive blood cultures was 100% in each group (p > 0.05). One hour after cecostomy the mean peritoneal severity score was significantly higher in the PP group than in the control group, but there was not any significant difference between groups 3 and 6 h after cecostomy. The mean peritoneal severity scores were found to be significantly increased with time when the PP groups compared with each other. Conclusion: In rats, pneumoperitoneum can't cause a more severe peritonitis but it does induce an increase in the rate of bacteremia within the early 6-h period of peritonitis. Received: 14 April 1997/Received: 18 September 1997     

Lobular carcinoma of the breast metastatic to the uterus in a patient under adjuvant anastrozole therapy

This is the first report of breast carcinoma metastatic to the endometrium in a patient on adjuvant anastrozole therapy. We report a case of metastatic lobular carcinoma of the breast in a 63-year-old patient on adjuvant anastrozole therapy for 8 months. She was asymptomatic and metastatic endometrium was diagnosed after transvaginal ultrasound revealed suspicious findings along with elevated Ca 15-3 levels. As further work up showed no other metastatic sites her uterus was taken out along with her ovaries and pelvic lymph nodes. Uterine metastases should be kept in mind in asymptomatic patients on anastrozole therapy.     

Long-term effect of pentoxifylline and NG-nitro-L-arginine methyl ester on testicular function in spermatic artery ligation

OBJECTIVE: To investigate long-term testicular function in pentoxifylline- and NG-nitro-L-arginine methyl ester (L-NAME)-treated rats prior to spermatic artery ligation by assessing serum inhibin B concentration, a reliable endocrine marker of spermatogenesis. MATERIAL AND METHODS: Forty prepubertal rats were randomly divided into four equal groups. Right orchiectomy was performed in all rats. Intraperitoneal pentoxifylline and L-NAME were administered to Groups 1 and 2, respectively. Rats in Group 3 did not receive any medication. The spermatic arteries of the left testes were ligated in all groups with the exception of the sham controls (Group 4). One month postoperatively, a histopathologic evaluation was performed and serum inhibin B concentrations were assessed in all groups. RESULTS: There were no statistically significant differences in testis size or serum inhibin B concentration between Groups 1, 2 and 3. However, the testes were significantly smaller (p(1)=0.01, p(2)=0.01, p(3)=0.01) and serum inhibin B levels were significantly decreased (p(1)=0.01, p(2)=0.01, p(3)=0.01) when Groups 1-3 were compared with Group 4. Histopathological evaluations revealed necrosis and calcification in all specimens with the exception of the sham-operated group. CONCLUSIONS: The long-term outcomes of spermatic artery ligation were poor and testicular atrophy developed in rat testes in all study groups. Testicular atrophy could not be reversed by preoperative administration of pentoxifylline and L-NAME.     

A Clinical Study of Colchicine in Childhood Asthma

A double-blind, randomized, crossover study was done to determine the efficacy of colchicine in 30 atopic children with moderately severe asthma. A constant dose of sustained-release theophylline and salbutamol by inhalation, as needed, was administered to all patients. Compared to placebo, colchicine, 0.5 mg twice daily, significantly reduced morning tightness and nocturnal asthma score. There was, however, no significant difference between colchicine and placebo for cough, daytime asthma, or daily combined symptom scores for each patient. Colchicine did not significantly decrease beta-2 agonist inhaler use when compared with placebo. Similarly, there was no statistically significant difference between placebo and colchicine therapy as far as pulmonary function tests and peak flow reversibility were concerned.

Thus, colchicine administered for 4 weeks demonstrated insufficient antiasthma activity. Colchicine-induced clinical improvement that was reported in a previous study may be due to selection of patients with mild asthma symptoms. However, our group, comprised of moderately severe asthmatic patients, did not show a satisfactory clinical response.     

The anesthetic management of a patient with Dorfman-Chanarin syndrome

Dorfman-Chanarin syndrome (DCS), which is also known as neutral lipid storage disease, is a rare autosomal recessive inherited lipid storage disease with congenital ichthyotic erythroderma. Since the Dorfman-Chanarin syndrome is a multisystemic disease the choice of drugs and the conduct of anesthesia in these patients are important. Preoperative evaluation should be performed in detail and anesthetic method and drugs to be used should be chosen carefully in accordance with affected system, overall state of patient and characteristics of the operation, in order to decrease perioperative morbidity rates in these patients. We report the anesthetic management of a child with DCS operated for correction of strabismus under general anesthesia.     

Reno-vascular hypertension in childhood: a nationwide survey

Renovascular disease accounts for 8–10% of all cases of paediatric hypertension, whereas, in adults, its incidence is approximately 1%. The Turkish Paediatric Hypertension Group aimed to create the first registry database for childhood renovascular hypertension in Turkey. Twenty of the 28 paediatric nephrology centres in Turkey responded to the survey and reported 45 patients (27 girls, 18 boys) with renovascular hypertension between 1990 and 2005. The age at presentation ranged from 20 days to 17 years. The mean blood pressure at the diagnosis was 169/110 mmHg. Chief complaints of symptomatic patients were headache (38%), seizure (18%), epistaxis (4%), growth retardation (4%), cognitive dysfunction (4%), polyuria (2%), palpitation (2%), and hemiplegia (2%). Renovascular hypertension was found incidentally in 11 children. The diagnosis of renovascular hypertension was established with conventional angiography in 39 patients, MR angiography in three, CT angiography in two, and captopril diethylene triamine penta-acetic acid (DTPA) scintigraphy in one patient. Twenty-one children had bilateral renal artery stenosis and 24 had unilateral renal artery stenosis. Of these, 14 (31%) had fibromuscular dysplasia; 12 (27%) Takayasu’s arteritis; six (13%) neurofibromatosis; two (5%) Williams syndrome; one (2%) Kawasaki disease; one (2%) mid-aortic syndrome; one (2%) extrinsic compression to the renal artery, and eight (18%) unspecified bilateral renal artery stenosis. Hypertension was controlled with antihypertensive drugs in 17 patients. Percutaneous transluminal angioplasty (PTRA) or surgery had to be performed in 28 patients: PTRA in 16 patients, PTRA + surgery in one patient and surgery in 11 patients (four nephrectomies). The importance of vasculitic disease, especially Takayasu’s arteritis, should not be underestimated in children with renovascular hypertension.