Body piercing: a growing problem for clinicians

Until recently body piercing was mainly confined to the ears and/or nose. In the last few years there has been a significant increase in the prevalence of body piercing which, in some instances, has had serious health consequences. This industry has the potential to significantly damage or interfere with health care. Urgent legislation is needed to remedy this situation.     

Moyamoya disease presented with migrainelike headache in a 4-year-old girl

A 4-year-old girl was admitted to our department with the complaints of severe headache, nausea, vomiting, and photophobia. She had a 1-year history of migrainelike headache that occurred every 1 to 2 months. Her neurologic examination was normal, but T-weighted axial magnetic resonance imaging (MRI) of the brain showed flow void within the basal ganglia owing to parenchymal vascular collaterals. Magnetic resonance angiography and digital substraction carotid angiography showed both occlusion of the internal carotid artery in the supraclinoid portion and extensive parenchymal vascular collaterals. Because there was no evidence of risk factors for cerebral arterial occlusion and cerebral infarct or hemorrhage, she was diagnosed as having moyamoya disease. In any case of atypical migrainelike headache, a detailed investigation should be kept in mind to detect an underlying vascular disease such as moyamoya.     

Specific site involvement in fixed drug eruption

A total of 105 patients with established fixed drug eruption (FDE) by oral provocation were evaluated with regard to a drug-related site involvement. Cotrimoxazole was the leading causative agent (63.8%), followed by naproxen sodium (23.8%), dipyrone (5.7%), oxicams (4.8%) and other rare causes (1.9%). Cotrimoxazole most frequently induced lesions on genital mucosa; naproxen and oxicams on lips; and dipyrone on trunk and extremities. Isolated FDE on male genitalia (n = 16) was exclusively because of cotrimoxazole. A highly significant association could be established between naproxen and FDE on lips (chi-square = 28.3; corrected P =.000002). As this study represents the largest series of patients with naproxen-induced FDE, we would suggest that naproxen should be considered as an important potential cause of FDE on lips.     

Inflammatory mediators in autoimmune lacrimal gland disease in MRL/Mpj mice

PURPOSE: MRL/MpJ-fas(+)/fas(+) (MRL/+) and MRL/MpJ-fas(lpr)/fas(lpr) (MRL/lpr) mice are congenic substrains of mice that have spontaneously developing lacrimal and salivary gland inflammation and are models for the human disorder Sj?gren's syndrome. Nitric oxide (NO) and tumor necrosis factor (TNF)-alpha are proinflammatory and potential mediators of tissue damage. The presence of the inducible form of nitric oxide synthase (iNOS), which catalyzes the production of NO, and the presence TNF-alpha in the lacrimal glands of MRL/MpJ mice were assessed. METHODS: Lacrimal glands from MRL/+ and MRL/lpr mice, at ages 1 through 9 months, were evaluated by real-time RT-PCR for iNOS and TNF-alpha mRNA and by immunohistochemistry for the presence of iNOS and of TNF-alpha. Age-matched BALB/c lacrimal glands were used as the control. RESULTS: By quantitative real-time PCR (qPCR), mRNA for iNOS was detected in the lacrimal glands in significantly greater amounts in both MRL/+ (median, normalized to 18S rRNA, 2.90; P < 0.0003) and MRL/lpr mice (median 6.84, P < 0.001) than in BALB/c mice (median 0.34). By qPCR, mRNA for TNF-alpha in the lacrimal glands was detected in significantly greater amounts in aged MRL/+ mice than in BALB/c mice (median, normalized to actin, 221.8 vs. 77.8, P = 0.011) and in MRL/lpr mice than in BALB/c mice (median 136.7 vs. 72.5, P = 0.001). Immunohistochemistry demonstrated both iNOS and TNF-alpha in scattered mononuclear cells throughout the lacrimal glands and in mononuclear cells at the junction of the focal inflammatory infiltrates and normal acinar tissue in both MRL/+ and MRL/lpr mice. CONCLUSIONS: As demonstrated by the greater presence of iNOS and TNF-alpha in the lacrimal glands of MRL/MpJ mice than in control glands, both NO and TNF-alpha are potential mediators of lacrimal gland damage in these murine models of Sj?gren's syndrome.     

Evaluation of patients with scleritis for systemic disease

OBJECTIVE: To evaluate the relationship between associated medical conditions and scleritis-particularly, the timing of the diagnosis of these diseases. DESIGN: Retrospective case series. PARTICIPANTS: Patients with scleritis presenting to a single center over an 18-year period. METHODS: Medical records were reviewed for the presence of an associated infectious or rheumatic disease and for the timing of the diagnosis of the systemic disease relative to the presentation for evaluation of the scleritis. MAIN OUTCOME MEASURES: Presence of an associated medical condition and timing of diagnosis relative to that of scleritis. RESULTS: In a series of 243 patients with scleritis, 44.0% had an associated medical condition: 7.0%, an infection, and 37.0%, a rheumatic disease. The most frequent infection was herpes zoster, and the most frequent rheumatic disease was rheumatoid arthritis, present in 4.5% and 15.2% of patients, respectively. Of the 107 patients with an underlying disease, 77.6% had a previously diagnosed disease, 14.0% had their conditions diagnosed as a result of the initial evaluation, and 8.4% developed a systemic disease during follow-up. Systemic vasculitis was less likely to have been previously diagnosed than other rheumatic diseases (59.1% vs. 83.8%, P = 0.015) and more likely to be diagnosed by the initial diagnostic evaluation (27.3% vs. 8.8%, P = 0.027). Ten patients (4.1%) had a positive antineutrophil cytoplasmic antibody (ANCA) test result without clinical evidence of a systemic vasculitis. Four of 5 patients with a positive cytoplasmic ANCA test result but no clinical evidence of systemic vasculitis required immunosuppressive drugs for control of the scleritis, whereas 1 of the 5 patients with a positive perinuclear ANCA test result required immunosuppressive drugs. Among patients with no evident systemic disease after the initial diagnostic evaluation, the rate of occurrence of a rheumatic disease was 4% per person-year. CONCLUSIONS: Although associated systemic diseases are frequent among patients with scleritis, the majority are previously diagnosed. Systemic vasculitis is less likely than other rheumatic diseases to have been previously diagnosed. Because vasculitis is a potentially life-threatening disorder, it should be a focus of the diagnostic evaluation.     

Effect of sildenafil citrate on retinal functions: preliminary report on Humphrey visual field analysis

OBJECTIVE: To assess the effect of sildenafil citrate treatment on visual field analysis (VFA) in patients using sildenafil citrate for erectile dysfunction. MATERIALS AND METHODS: In this prospective study on 18 male volunteers with erectile dysfunction, bilateral VFA was performed using the Humphrey 30-2 central standard threshold test. White-on-white (W/W) and blue-on-yellow (B/Y) protocols were used prior to treatment (baseline VFA) and after treatment (repeat VFA) with sildenafil citrate. W/W and B/Y baseline VFA and repeat VFA mean deviations (MD) were compared. RESULTS: The baseline MD for W/W and B/Y protocols were -1.34 +/- 1.8 and -2.59 +/- 2.1 dB, respectively, whereas the mean repeat MD for W/W and B/Y protocols were -1.79 +/- 2.21 and -2.83 +/- 3.31 dB, respectively. There was no statistically significant difference between W/W and B/Y baseline and repeat VFA with respect to MD (p > 0.05). CONCLUSION: Sildenafil citrate causes no significant changes in Humphrey VFA in patients with erectile dysfunction.     

Effect of immunotherapy on autoimmune parameters in children with atopic asthma

There is an increased rate of reported autoantibody production in patients with atopic and nonatopic asthma. The possibility of generating autoantibodies after the induction of immunotherapy can be explained by several mechanisms. One of these is immune deviation from TH2 to TH1 response by the effect of immunotherapy in favor of unregulated response to self-antigens. The other theory is a possible antigenic mimicry enabling autoantibody formation in these patients, Sixty-three atopic asthmatic children were included in the study. The patients were divided into three groups: Group I: patients with atopic bronchial asthma without immunotherapy: Group II: patients receiving immunotherapy for a maximum of 3 years; Group III: patients receiving immunotherapy for 4-5 years. The autoantibodies examined in the study population were anti-nuclear antibody, anti-double stranded DNA, rheumatoid factor, liver-kidney microsomal antibody, anti-mitochondrial antibody, anti-thyroglobulin and anti-microsomal antibody, anti-Smith antibody and lupus anticoagulant. An overall incidence of 17.5% autoantibody positivity was observed in patients, with no statistical significance between the treatment groups. IgG levels were significantly elevated in Group III when compared with Group I. Based on these findings it is suggested, in accordance with other studies, that long-term immunotherapy in the pediatric age group does not cause a significant autoantibody formation other than the overall increased incidence that occurs in asthmatic patients.     

Early first trimester ultrasound examination. Is it really efficient in the clinical management of the pregnancy?

Objective: This is a retrospective study accomplished to determine the efficiency of the first trimester ultrasound examination especially when performed on elective conditions. Materials and Method: The records of patients who had undergone early first trimester transvaginal ultrasound in Obstetrics and Gynecology Department of Cerrahpasa School of Medicine, Istanbul University between from January 1999 to December 2000 were reviewed. The records of 426 patients were eligible for the analysis. The age, parity, gestational week that the ultrasound performed, the complaint on appliance, the features visible on the ultrasound were noted. The patients were divided into two groups: patients without any complaint (Group 1) and patients applied with any complaint (Group 2). The prognosis of the pregnancy was determined through the follow-up. On the statistical analysis, χ-square test, student-t test, Pearson correlaton analysis and multiple linear regression analysis were utilized. Results: In group 1, 79% of examinations were normal whereas the rate of normal ultrasound was 50% in group 2. The difference between the groups was statistically significant (p=0.000). On group 1, 7 subsequent abortions, 7 missed abortions and one case of mole hydatiform were identified (7.6%). When the patient applied with a complaint, ultrasound examination revealed abnormal findings that enabled to reach an accurate diagnosis in 29.9% of these patients. 50 abortions (inevitable or incomplete), 13 missed abortions, 3 ectopic pregnancies and 2 mole hydatiform were diagnosed. The difference between the two groups according to ability to reach a diagnosis on the initial ultrasound was statistically significant (p=0.000). Conclusion: The value of ultrasound examination before the 10th weeks of pregnancy is not validated when the patient has no complaint even if it appears as the most powerful mean to assess the accurate gestational age and observing fetal cardiac activity is the best prognostic variable for the outcome of the fetus. Received: 28 October 2001 / Accepted: 18 November 2001 Correspondence to A. Gezer     

Current Diagnosis and Transoral Surgical Treatment of Eagle’s Syndrome

PURPOSE: The purpose of this study was to discuss the current diagnosis of Eagle's syndrome and to present our experience in transoral surgical treatment of the syndrome. MATERIALS AND METHODS: Nineteen patients with Eagle's syndrome due to elongated styloid process were included in this clinical trial. Diagnostic work-up also consists of 3-dimensional computed tomography scanning in recent cases. Elongated styloid processes were resected via transoral approach under general anesthesia. RESULTS: Three-dimensional computed tomography scanning depicted how the preoperative estimation of the styloid length correlated with the true styloid length measure intraoperatively. No postoperative complications were encountered, while the chief symptoms of all patients regressed after surgery. CONCLUSIONS: Three-dimensional computed tomography scanning is an advanced technique that can measure the definitive length of styloid process and takes the physician straightforward to the exact diagnosis. The transoral approach is a safe surgical alternative that achieves adequate treatment of Eagle's syndrome.