Celiac disease with various presentations

BACKGROUND: Celiac disease (CD) has a wide clinical spectrum from malabsorption syndrome to extra intestinal presentations. A total of 45 children with CD presented with mainly chronic diarrhea (n :23), anemia (n: 12), and short stature (n: 10) were evaluated in this study. The aim was to find common parameters of CD with various presentations. METHODS: Basic anthropometric, biochemical and hematological parameters in cases with CD with various presentations were compared. RESULTS: It was found that children with CD presenting with chronic diarrhea were younger. There was no significant difference in hemoglobin levels in children with CD presenting with anemia. Children with CD with short stature had significantly lower serum vitamin B(12) levels and lower levels of height standard deviation scores, bone age delay, and alkaline phosphatase. CONCLUSIONS: It was concluded that children, especially infants with chronic diarrhea with CD, may not be affected with generalized malabsorption. Anemia and short stature are frequent findings in cases with CD whether they are main presenting symptoms or not. Children with CD presenting with short stature may have lower levels of vitamin B(12) than other presentations.     

Comparison of lymphocyte populations in cutaneous and electrical burn patients: a clinical study

Immunosuppression following thermal injury has been noted in recent years. Both cellular and humoral immune systems have been reported to be affected. The present study aimed to compare the quantitative differences between cutaneous and electrical burn patients in respect to the partition and levels of lymphocyte populations. From March 1997 through February 1998, 15 patients with major thermal injury or high voltage electrical injury were included in this clinical prospective study. Blood samples were collected at three and seven days postburn. The evaluation of lymphocyte populations of patients was performed by SimulTest IMK plus. T cell and B cell populations, activated T cells, natural killer and helper T cell levels were all suppressed in both groups. Suppressor T cell levels were elevated in electrical burn group at both three and seven days. Therefore, CD 4/CD 8 ratios were more suppressed in electrical burn group. In conclusion, lymphocyte populations in electrical burn patients and also contributing factors which play important roles in the development of sepsis in both group need to be investigated further.     

Gender differences in polysomnographic findings in Turkish patients with obstructive sleep apnea syndrome

In this study, we evaluated the gender differences in body mass index (BMI), age and their effects on apnea–hypopnea index during total sleep time (AHI_TST) in the Turkish population who were diagnosed with obstructive sleep apnea syndrome (OSAS) and compared them with data from the literature. A computerized database of 244 Turkish patients (194 males, 50 females) who had undergone overnight polysomnography (PSG) and diagnosed with OSAS at Bayındır Hospital sleep laboratory between October 2004 and January 2007 was reviewed. The male:female ratio of the patients was 3.88:1. Male patients were significantly younger compared to females (48.87 ± 10.82 vs 52.94 ± 12.14 years, respectively, P = 0.003). The BMI and AHI_TST were similar in male and female patients (BMI = 29.52 ± 4.63 vs 31.17 ± 6.08 kg/m², respectively, P = 0.083) (AHI_TST = 27.45 ± 22.97 vs 24.77 ± 23.83, respectively, P = 0.149). For the male and female groups, AHI_TST increased as BMI increased (P = 0.03, 0.04). The median values of AHI_TST in male group, for the normal, overweight and obese + pathological obese groups were 12.45, 20.20 and 23.50, respectively, whereas the median values of AHI_TST in female group were 11.10, 10.95 and 26.20, respectively. In the normal and obese + pathological obese groups, there was no statistically significant difference according to gender, whereas in the overweight group, male patients had significantly higher AHI_TST (P = 0.02). There was no statistically significant difference between the male and female patients regarding the severity of OSAS (P = 0.358). However, there was a male tendency to moderate and severe OSAS in the normal and overweight BMI groups. In Turkish patients with OSAS, there was no gender difference in BMI and AHI_TST and female patients were significantly older than the males. The OSAS was diagnosed in men nearly four times more often than in women.     

Circulating concentrations of adiponectin and tumor necrosis factor-alpha in gestational diabetes mellitus.

Adiponectin and tumor necrosis factor-alpha (TNF-alpha) have been implicated in insulin resistance and diabetes mellitus (DM). In the present study we investigated levels of adiponectin and TNF-alpha and their relationships with each other and metabolic factors in women with gestational DM (GDM). Thirty-four pregnant women with GDM and 31 pregnant women with normal glucose tolerance (NGT) were included in the study. Plasma adiponectin levels were lower in GDM than in NGT (36.9 +/- 6.7 vs. 61.3 +/- 13.0 ng/ml, p = 0.028). Serum TNF-alpha levels were increased in GDM compared with NGT (20.5 +/- 2.4 vs. 14.0 +/- 1.5 pg/ml, p = 0.042). After adjustment for pre-pregnancy and current body mass index (BMI), adiponectin levels correlated negatively with insulin resistance by homeostasis model assessment-insulin resistance (HOMA-IR) and 0-h and 1-h glucose both at glucose challenge test and oral glucose tolerance test in GDM. Adiponectin levels were correlated only with very low-density lipoprotein cholesterol and triglyceride levels in NGT. TNF-alpha levels were correlated with glycated hemoglobin in GDM. There was a significant positive correlation between TNF-alpha levels and pre-pregnancy and current BMI in GDM as well as NGT. HOMA-IR for adiponectin and pre-pregnancy BMI for TNF-alpha remained as significant determinants in multiple regression analyses. In conclusion, these data suggest that reduced adiponectin and increased TNF-alpha may be involved in the pathogenesis of GDM.     

Assessment of penile bone graft viability by bone scintigraphy: A case report

A 20-year-old man, who had penile reconstruction surgery with an iliac bone graft a year ago due to malcircumcision at 6 years old underwent bone scintigraphy in order to detect bone graft viability. The accumulation of 99mTc-MDP in the penile region revealed the viability of the bone graft. This case report shows that bone scintigraphy can be used to assess the viability of a bone graft located inside the penis as well as bone grafts placed elsewhere in the extremities.     

Community-acquired severe staphylococcal septicemia in children: The relationship with blunt trauma

Abstract Background. With the aim of establishing the role of blunt trauma, a trauma without any fracture or obvious wound, as a risk factor in children who were admitted for community-acquired severe staphylococcal septicemia with various organ involvement, 63 patients were investigated during a seven-year study period. All children were previously healthy.
Results: Blunt trauma was present in 12 (46%) of 26 septicemic patients in whom skeletal infections were diagnosed and the relative risk of trauma was high (odds ratio 15.0; confidence interval 2.9–75.8, P< 0.001) in these children. Patients with multiple organ involvement and with multifocal skeletal infections were more frequent among traumatized patients. Children with skeletal involvement were significantly older than others ( P< 0.001). The period between the first symptom of infection and the diagnosis was shorter in traumatized children (P < 0.001). None of the children with staphylococcal pulmonary or soft tissue infection had any history of trauma. We conclude that blunt trauma is one of the important risk factors for skeletal involvement in staphylococcal septicemia. Its immunosuppressive nature, especially in local damage of the skin barrier, may be the cause of seeding and multifocal infection.     

Destructive membranous periodontal disease (ligneous periodontitis): a case report and 3 years follow-up

Destructive membranous periodontal disease is a rare, destructive and poorly defined entity, which is the part of a systemic disease due to plasminogen deficiency and fibrin deposition. The disease is characterised by gingival enlargement and periodontal tissue destruction that leads to rapid tooth loss despite treatment attempts. Biopsy is essential to rule out other periodontal disease in the differential diagnosis.     

Primary rectal lymphoma: an unusual treatment for a rare case

Lymphomas may be localised throughout the whole gastrointestinal tract, from oral cavity to rectum. The rectum is a fairly uncommon site for lymphoma compared to other gastrointestinal sites. Primary rectal lymphoma is the rarest disorder accounting for 0.1-0.6% of all colonic malignancies, and 0.05% of all primary rectal tumours. It is unclear whether surgery, chemotherapy, radiotherapy or combinations of these treatments improve the prognosis and survival rate in such patients. The role of surgery in primary rectal lymphoma of the rectum is still controversial. A case of primary rectal lymphoma treated by a combination of chemotherapy and radiotherapy is described.