Foamy histiocytes in a patient with visceral leishmaniasis after treatment with liposomal amphotericin B

A seven-year-old patient was admitted to our hospital with the complaints of fever, malaise, and abdominal distention. In the bone marrow aspiration smears, leishmania amastigotes were observed. The patient was diagnosed as having visceral leishmaniasis (VL) and treated with liposomal amphotericin B (L-AMB). The authors report their observation of foamy histiocytes seen in the bone marrow aspiration smears of the patient with VL after L-AMB treatment. This effect of L-AMB needs to be recognized, since L-AMB may represent a further condition in addition to the other diseases that are associated with foamy histiocytes in the bone marrow.     

Comparison of double balloon enteroscopy in adults and children

AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients. METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative en-ema. The patients were followed up for 2 h after the procedure in terms of possible complications. RESULTS: DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); PeutzJeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation. CONCLUSION: With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.     

Loss of bone mineral density in renal transplantation recipients

Aim

This study investigated the prevalence and contributing factors of loss of bone mineral density after renal transplantation among Turkish patients.

Patients and Methods

The study included 70 subjects, namely 50 males and 20 females of overall mean age of 36.94 ± 10.09 years. We measured femoral neck mineral density by dual-energy X-ray absorptiometry (DEXA). A T score above −1 was defined as a normal bone mineral density compared with T scores of −1.0 to −2.5 or below −2.5 which were defined as either osteopenia or osteoporosis, respectively.

Results

At a median duration of 23 months after renal transplantation, osteopenia or osteoporosis was observed among 30 (42.9%) or 30 (42.9%) of the 70 patients, respectively. The mean body mass index (BMI) value was significantly higher among the normal than the osteoporotic group: 27.59 ± 4.66 kg/m² vs 24.18 ± 3.57 kg/m², respectively. However, no significant differences occurred in terms of BMI among the other groups. The amount of proteinuria was significantly lower in the normal than the osteopenic or osteoporotic group: (12.5 (range, 10.0-20.0); 105.0 (10.0-2800.0) or 215.5 (10.0-1880.0) mg/d (P = .001 and .004, respectively). In contrast, there was no significant difference between the amounts of proteinuria displayed by the osteopenic group and the osteoporotic group (P < .05)]. These patient groups showed no difference in age, gender, donor source, cause of end-stage renal disease (ESRD), pretransplant dialysis modality, duration of dialysis, use of a vitamin D preparation, immunosuppressive regimen, posttransplantation period, levels of iPTH or 25 hydroxy vitamin D3 (25OH vit D), exposure to tacrolimus or cyclosporine (CyA), calcium × phosphate product, serum albumin and hemoglobin content, creatinine clearance, or serum bicarbonate concentrations (P > .05).The T scores of the femoral neck correlated with BMI (r: 0.415; P = .001), 25OH vit D level (r: 0.268, P = .026), creatinine clearance (r: 0.273, P = .022), and serum glucose level (r: 0.349, P = .003). It inversely correlated with the amount of proteinuria (r: −0.263, P = .028), serum alkaline phosphatase level (r: −0.329, P = .005), and serum magnesium concentration (r: −0.252, P = .035). Upon multivariate analysis, BMI and 25OH vit D level were observed to be independent risk factors for loss of femoral mineral density.

Conclusion

Loss of bone mineral density is a common complication that correlates with low BMI values and decreased 25OH vit D levels as major risk factors for this problem.     

Early or delayed limb lengthening after acute shortening in the treatment of traumatic below-knee amputations and Gustilo and Anderson type IIIC open tibial fractures: The results of a case series

We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.     

The frequency of skin diseases among students in a university clinic

This study was conducted to assess the frequency of dermatologic diseases in Turkish university students. University students who visited two dermatology outpatient clinics within the Ege University Health, Culture and Sports Office were included in the study. Each student was examined by two dermatologists. Questions about demographic data and information about the frequency of using the swimming pool were directed to the patients. All dermatological diseases were recorded. Patients were asked to assess and give a score for the state of their mental wellness using the visual analog scale (0-100) during the past month. Chi-square and Student t tests were used for statistical analyses. A total of 1733 individuals, 750 (43.3%) men and 983 (56.7%) women, were included in the study. The most frequently seen diseases were acne vulgaris (40.1%) and fungal diseases (17.08%), whereas the least frequently seen were parasitic skin diseases (0.46%) and vascular diseases (0.51%). The mean mental wellness score was found to be 61.03 +/- 21.34 (0-100, median: 65.00). It can be concluded that students visit university dermatology outpatient clinics frequently and the most common complaints are acne vulgaris and fungal diseases.     

Impact of mode of delivery on skin microcirculation in term healthy newborns within the first day of life

Background: Microcirculation is an important component of hemodynamic physiology. It can be assessed simply by clinical scores or by a variety of techniques including sidestream dark field (SDF) imaging and peripheral perfusion index (PI) measurements. Mode of delivery may have affects on microcirculation during transitional period. The aim of this study was to compare skin microcirculation in newborns born via vaginal delivery (VD) or cesarian section (C/S).

Methods: Term healthy newborns not requiring NICU admission were included. Vital signs were recorded. Skin microcirculation was determined by clinical scoring including capillary refill time, skin color, warmth of extremities, by SDF imaging where capillary density and microvascular flow is determined and by PI measurements where pulsatile and nonpulsatile capillary flow is measured. Assessments were done at 30?min and 24?h of life. Results were compared between VD and C/S groups and overtime.

Results: There were 12 newborns in VD group and 25 newborns in C/S group. No difference was observed in microcirculation assessments between groups. However VD group had increased hyperdynamic flow overtime.

Conclusion: In healthy term newborns microcirculation does not seem to be affected by mode of delivery, however results may differ in sick or preterm newborns.