Crimean-Congo haemorrhagic fever cases in Turkey

Crimean-Congo haemorrhagic fever (CCHF) is an arbovirus infection, which is transmitted through ticks or via blood and secretions. Until recently, human cases of CCHF were unknown in Turkey; however, several acute disease cases were reported in 2002. We report on the investigation of a cluster of suspected CCHF cases in the middle part of the Black Sea from May 2002 to October 2003. The medical charts that we reviewed were obtained from all local physicians and our field investigations. 'Suspected case' was defined with regard to time, place, and both clinical and laboratory characteristics. A total of 108 patients were defined as suspected case. Among them 36 patients were reached and blood samples taken for examination for CCHF by using ELISA and RT-PCR. According to the laboratory analysis, 80.6% (29/36) were acute cases and 8.3% (3/36) were past CCHF infections. The overall mortality rate was 5.6%. There was no nosocomial infection; however, there were 2 family clusters. Tick exposure was the most prevalent risk factor (74.2%). A multidisciplinary collaboration should be developed in order to understand the magnitude of the disease and also to keep it under control.     

Two sisters with breast tuberculosis

Breast tuberculosis is a rare form of extrapulmonary tuberculosis. Two sisters diagnosed with mammary tuberculosis and having a family history concerning pulmonary tuberculosis in other siblings were presented in this study; and thereby breast tuberculosis was discussed by evaluating similar cases of breast tuberculosis published in our country. The ultrasonography examinations of the cases (26/F, 27/F) with history of mass, enlargement, pain and discharge complaints were reported as being consistent with fibrotic mastopathy and inflammation. Patients having the diagnosis of breast tuberculosis after the excisional biopsy were undergone HRZE treatment. After the antituberculosis regimen, a complete resolution of the lesion in the breast was observed in our first case which had concurrent pulmonary tuberculosis. The lesion of our second subject who had isolated mammary tuberculosis showed marked improvement. Our cases are still being followed up without any complaints. In conclusion, breast tuberculosis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis as our country.     

Rosai-Dorfman disease with epidural and spinal bone marrow involvement: magnetic resonance imaging and diffusion-weighted imaging features

Sinus histiocytosis with massive lymphadenopathy (SHML), or Rosai-Dorfman disease, is a rare histiocytic disorder that typically presents with chronic, self-limiting cervical lymphadenopathy. Although this disease mainly affects histiocytes, there are a few reports of bone marrow infiltration. Diffusion-weighted imaging (DWI) is a promising technology in differentiating between various bone marrow pathologies. We here present conventional magnetic resonance imaging and DWI features of a patient with SHML and bone marrow involvement.     

Differential effects of STAT5 and PI3K/AKT signaling on effector and memory CD8 T-cell survival

During viral infection, effector CD8 T cells contract to form a population of protective memory cells that is maintained by IL-7 and IL-15. The mechanisms that control effector cell death during infection are poorly understood. We investigated how short- and long-lived antiviral CD8 T cells differentially used the survival and cell growth pathways PI3K/AKT and JAK/STAT5. In response to IL-15, long-lived memory precursor cells activated AKT significantly better than short-lived effector cells. However, constitutive AKT activation did not enhance memory CD8 T-cell survival but rather repressed IL-7 and IL-15 receptor expression, STAT5 phosphorylation, and BCL2 expression. Conversely, constitutive STAT5 activation profoundly enhanced effector and memory CD8 T-cell survival and augmented homeostatic proliferation, AKT activation, and BCL2 expression. Taken together, these data illustrate that effector and memory cell viability depends on properly balanced PI3K/AKT signaling and the maintenance of STAT5 signaling.     

Cushing syndrome caused by topical corticosteroid: a case report

Development of iatrogenic Cushing syndrome from topical steroid therapy is very rare in adults. A 48-year-old woman with a diagnosis of Cushing syndrome caused by long-term topical clobetasol propionate application was presented. Laboratory studies were consistent with adrenal suppression that improved after discontinuation of the use of topical glucocorticoids. Patients who will take treatment with steroids, even with topical steroids, should be offered information about the dose, duration, and type of the treatment and its systemic side-effects.     

Identifying cardiovascular risk factors in a patient population with coronary artery ectasia

Coronary artery ectasia (CAE) is frequently considered as a form of coronary artery disease. Cardiovascular risk factors were determined in a patient population with CAE. The 51 patients with isolated CAE (group 1), 61 patients with CAE coexisting with significant coronary stenosis (group 2), and 62 subjects with significant coronary stenosis (group 3) were included in the study, and the distribution of cardiovascular risk factors was compared. Thirty of 51 patients with isolated CAE had presented with typical angina pectoris, 8 patients with unstable angina pectoris, and 13 patients had atypical chest pain or palpitation. The 21 of 51 patients with isolated CAE had definitive positive treadmill exercise test results. Positive family history was similar in each group. The history of smoking was similar in group 1 and group 2 but higher than group 3. Frequency of hypertension was similar in group 1 and group 2 but higher than that in group 3. Frequency of diabetes mellitus was similar in group 1 and group 2 but lower than group 3. Plasma lipid levels and the number of patients with lipid disturbances were also similar in each group. In addition, C-reactive protein (CRP) levels were above the normal limits and there was no difference among groups with respect to plasma CRP levels. CAE appears to be associated with traditional cardiovascular risk factors such as hypertension, smoking, and hyperlipidemia. In addition, elevated CRP level in patients with CAE may suggest the role of inflammatory process in development of CAE.     

Pyelovenous fistula: a rare cause of hematuria

A 72-year-old female who was admitted to our urology clinic with painless intermittent macroscopic hematuria existing for 3 months with no other voiding symptom was diagnosed with left pyelovenous fistula. Although a rare condition, pyelovenous fistula should be kept in mind when the cause of macroscopic hematuria cannot be diagnosed with routine radiological examinations, and retrograde pyelography should be the method of choice for the diagnosis in this rare condition.